Champion's story

One great thing about my current job is that I often get to combine my passion for physical therapy with my passion for running. I frequently have the opportunity to help local runners recover from injuries. Recently, I have helped a few of the faster runners in the community manage injuries. This has great for a few different reasons. Of course, it is great to help these people just like it is satisfying to help all the other clients I work with. It has also been fun to observe how these elite runners deal with injury. In many ways, to me, these are defining moments.

First off, what I have noticed is that the champions shift gears quickly. This happens in a couple different ways. First, they listen to what their bodies are telling them. If they feel tired or sick, they do not push past this. They listen. Second, when they experience pain, they listen very closely. The quick shift with respect to pain occurs with the mode of training they choose. If the pain prevents them from running, they do not dwell on it. Instead they go directly to the next best mode of training. This might be riding a bike if an injured tendon can't take ground reaction stresses. It might be switching to pool running if dealing with a stress fracture. Point is that there is no feeling sorry for themselves. There is a goal, and most recognize that dealing with injury is just part of the game.

One thing I love too is that these runners value and respect their inner circle of advisors. They listen to themselves, their coaches, and their PT's! If they need to shut it down, they do. In the long run, they are back to training more quickly for it.

The title of this entry comes from Jerry Lynch, who is a sports psychologist. He has published many books which I have thoroughly enjoyed. He is a former competitive runner himself so he frequently comments about advising runners. One concept he touches on is the Champion's story. He notes that the best runners will set goals, and then write the 'story' to achieve them. The 'story' can be how they train, rest, eat, and of course, deal with injury. Good stuff. Check it out.

Side Note: The photo at the top is of "Ocho". This past season Bill Potts and I raced numerous times. At the Capon Valley 50k, we raced a 'pinkie' run, our term for a fun run where we run together thoughout the entire race. It was a great race. We ran steady to an 8th place finish. The awards table for top ten finishers had many quirky handmade crafts. I chose Ocho for my award. He sits in the bedroom as a reminder of my champion story: train hard, run smart, and have fun! Thanks Bill.....

Managing time off from injury

Dealing with an injury is always a challenge. Many runners that I see in the clinic struggle with injury. Their focus often settles on what they can't do: run. My role as a PT often encourages injured athletes to change their focus onto what they CAN do intead. There are plenty of options out there for the injured. In most instances, the focus should be on relative rest versus complete rest. Obviously if the athlete is dealing with 7+/10 pain, then complete rest is the answer. Most nagging running injuries tend to be in the 0-3/10 pain range. At this level, it is ok to keep running as long as ther is no obvious impairment of ruuning form. It is in the middle ground, the 4-6/10 pain range, that the cross training and relative rest is key. I like to think of it as the pushing buttons range. The reason being that most runners just want to run. They usually do not want to fool with much else. That is except for the champion runners who recognize the value of mixing it up when they can't run at the level they want.

As I mentioned above, there are numerous different modes of exercise for the injured runner.
At the top of the list is pool running. This form of exercises most closely follows the actual form of running. In deep water, an athlete can go through the motions of running without having to deal with the ground reaction forces that typically are pounding on the legs. It is a great first choice to take a load off. It requires the use of a buoyancy belt and not a whole lot else. I typically cup my hands into small paddles so I can actually move back and forth in the pool. I suggest that the runner focuses on the movement of their legs so they can try to mimick their on-ground form. Many studeis suggest that pool running can maintain fitness for up to 6 weeks. If you think about this in terms of common running injuries, think stress fractures, it works out quite well. A runner can maintain fitness and in 6 weeks be nearly healed.
A progression from deep water pool running would be running in shallow water. It requires water shoes so you do not tear up the soles of your feet. The buoyancy effect unweights most of the body weight but now the runner enjoys the benefits of weightbearing, albeit usually only 25% of bodyweight. Running against the resistance of the water causes the runner to forward lean whihc encourages a mid foot strike. Needless to say, these running form priciples are key for on-ground running.

Another option for injured runners is the use of an ellitical machine. There are many makes and models out there. One in particular I like is made by Cybex. The machine has a large foot platform and optional hand use to work the arms. The fluid motion of the machine cycle very closely mimicks running. Resistance can be added for increasing the intensity of the work. It is a great machine that i now use as an adjunct to my normal training even when not injured. I can use it in place of a recovery run. I can the work for my legs without the pounding. I can then proceed directly to my core/lifting routine without a hitch.

Using an exercise bike is another option for injured runners. It hardly mimicks running but think of it as just priming the engine. You are getting a hearlt rate response which get the cardiovascular system active. With runners who are not able to weightbear, I frequently start with use of the bike.

One question I often get from clients is "how do I know if I can still run my target race after this injury?". Advance Marathoning by Pfitzinger provides a useful guide. It breaks down the number of days missed because of injury compared to number of days to target race.

<10 days missed: resume schedule if race is 8weeks or more away, AND if it is less than 8 weeks off

10-20 days missed: resume schedule if race is 8 weeks or more off. REVISE goal if less than 8 weeks off

>20 days missed: Revise goal if race is 8 weeks or more off, AND revise goal if race is less than 8 weeks off.

Nothing too fancy there but it provides a framework to get started on regarding whether you can keep targeting a race or if you should realistically chose another one. Hope it helps......

Time to heal

One of my favoirte places to run is the C+O canal towpath. The painting on the left was done by a local artist of the canal. I love it and was excited to share. Enjoy!

To continue the thought on my recent leg injury, in hindsight one of the key mistakes I made, which you can learn from, was that I disregarded the basics of time required to heal. I let the runner side of me trump the clinician side. What I mean is that when you suffer an injury, there is a certain amount of time that needs to pass before the body can reasonably heal itself. This same concept applies to other areas of rehab. For example, it takes a certain amount of time before a weakened muscle can get stronger, no matter how much effort you put into it.
With my recent leg strain, I tried to rush back too quickly. I barely gave the muscle 24 hrs to heal which is simply too short. I iced, wrapped, and elevated the bugger. It felt better so I tried to get right back to it. As a clinician, I know that there are stages of soft tissue healing whihc were not being respected. The phases of healing are: 1) Inflammatory 2) Reparative and 3) Remodeling. The length of these phases will be different depending on what part has been injured. For example, an injured tendon might take a month to cycle through the reparative phase versus 2.5 weeks for a muscle.

With my injury, an injured muscle, the inflammatory phase happens quickly which is why the initial repsonse is key. As mentioned previously, ice and compression can help tremendously in this stage. I often encourage people to shy away from advil and the like. The reason for this is that inflammation is the first step of healing so we do not want to impede it from occuring. The healing occurs in a stepwise fashion so to block the step which initiates the other steps is not recommended.

New muscle fibers can appear in 18 days from the injury. By day 21 the muscle fiber is able to generate tensile force. So, when you think about the above information, you must consider where you are in the healing process. If you are one week post injury, realise that the muscle simply has not had enough time to heal to the point where it can be asked to perform. Consequently, a runner needs to focus not on running but rather the crosstraining to maintain the current base of fitness. 3 weeks into it is a distinctly different place as far as the healing goes. It is more appropriate to start thinking about actually getting back into the basics of running.

Each person heals differently based on age, sex, medical history etc. Use the above info to stimulate thoughts on managing injury. Obviously, when injured it is best to have a health care provider advising you on an indiviual basis. Happy trails.....

Grasshopper

I knew it had to happen. As a clinician, the statistics on running injuries are pretty ugly. Even still, I have been injury free for years. Of course, there is the little stuff that you can train through like a sore achilles. I had not been forced to stop running since I had torn my meniscus 3 or 4 years ago. All this changed a couple weeks ago.

At the end of a typical loop leaving from the gym, I suddenly had crazy sharp pain in my right calf. Basically, continuing to run was simply not an option. I walked a half mile back to work sort of scratching my head about what was going on. My focus was on what had been different in my training. My experience in the clinic tells me that most injuries occur in a transitional period: increases in miles, intensity, or frequency are typical culprits. The strange thing was that I was not in such a period. I had gently returned to running after the Grindstone 100. I thought about my shoes, which that day were my Newtons. I am new to Newtons but they had really treated me well to date. It was not as if the shoe was new to me. Then I thought about the recent training. I had just done a 19 miler with Team Jackass at a steady clip, marathon pace plus 20 seconds. I felt good most of the way. Thinking back another couple weeks I recalled an ankle sprain on the same leg while on the Rock Creek trails. It was a good sprain, the type where you feel the bones clunk. It hurt, but not horribly. I iced immediately and took a break from running for a few days. Without swelling or pain I took back to running. In hindsight, this might have been my first mistake. The best I could do as far as my leg strain goes was that I was compensating for the twisted ankle which caused me to overtax the muscles of my lower leg.

Second mistake for grasshopper was trying to get back to running too soon. I felt the sharp pain on a Thursday, and tried to run two days later. It was such an amateur mistake. I am embarrassed that the PT in me did not smack down the runner in me. It is a testament to the passion of running in us. So I tried to run too soon and made it significantly worse. I felt a pop in the muscle as I gimped back to the car with my buddy Mike Yuengling. The posterior tibialis was in complete rebellion/ shut down mode. I was done for a few weeks at least.

There are a variety of lessons to be learned here. I should know better how to manage these things because I do it every day. Learn from the clinician Doctor G, not the runner Bobby G!

One quick lesson, with more to follow, relates to listening to your body. I frequently help athletes recover from injury. I ask them to rate their pain on a 0 to 10 scale.

If the pain is in the 0 to 3 range, I am ok with resuming normal activity. For a runner, I ask that if the pain is causing them to limp then all bets are off. Otherwise they can gently try to run.

If the pain is in the 4 to 6 range, it is most appropriate to switch gears to cross training. For a runner, as with most other athletes, I like the stationary bike, elliptical, or the pool. Depending on the injury, one might be better than the other. You want to cross train until the pain drops back into the 0-3 range.

If the pain is in the 7 to 10 range, it is time to just shut it down. Focus on letting things calm down. Go back to the basics: ice, compression, elevation, and relative rest. Do this until the pain subsides so you can begin to gently train again.

A key element with the above recommendations is that the athlete is honest with how they assess their pain. No cheating in other words. It is an accurate assessment of the pain. If your pain is a 5/10 but you really want to meet your training buddies for a run then it does not become a 3/10. Recovery from an injury should be about changing training such that you can stay active and heal at the same time. More to follow on that.....

Ryan Hall

We had a great time over the weekend with the Pacers crew(www.runpacers.com) at a benefit for Ryan and Sara Hall's foundation (http://www.thestepsfoundation.org/). I had fun chewing the fat with Ryan about a variety of topics. You quickly realize that he and his wife are just ordinary people who just happen to be darn fast runners. Ryan is a big supporter of the importance of cross/strength training. This is something that I emphasize with many of the runners I work with so having him on my side is great. It was a thrill to be a part of the event.

I mentioned to Ryan that I would see him in Boston next year. Somehow I think my corral will be a bit further back than his.........

hit the FUN button

You gotta love this time of year for training. The temperatures are cool, the air crisp, and the recent snow adds a certain beauty to the DC landscape. For me, this time of year is a transitional one. I am winding down one season and looking forward to another one. With a focus marathon training program, each workout should have a goal. For example, the goal of the long run is to build endurance by raising aerobic metabolism. The tempo runs are slotted for developing a runner's anaerobic threshold. Following a structured program for multiple races can leaving feeling drained. As a result, it is important to really focus on taking some down time this time of year. Enjoy the freedom of not having a goal for each run or workout. Go for a hike with family, run around playing games, or try a spin class. All of these examples will allow you to be active, maintaining fitness, without the drain of hitting a target pace or distance. Have fun with your down time. Doing so will ready you for the next training cycle. It is better to start next season mentally fresh than still sluggish from too much work when rest is needed.
This time of year I love to get out on the trails in Rock Creek Park. It is a beautiful area with challenging terrain. The uneven terrain gives the balance system a bit of work, and the hills certainly help maintain all the glute strength from the cross training. My gait is constantly changing on the trail which helps reduce the stress load on my muscles and tendons. This time of year is a great time to allow the body to rest and heal. Bottomline is there are times to just have fun. For me, the time is now. Pull on those goofy socks and run just for the love of it. Think about how much fun Boston will be in April.......

Post marathon recovery-stretching

You have that glow about you. The post marathon glow. Maybe it is a post ultra glow. Either way, just enjoy the glow and reward yourself with some much needed downtime. Whether you are a first timer to the marathon, or perhaps recently tried to set a PR, the period after a marathon should ideally be focused on recovery. Forget about one race before you start planning the next. The recovery period is going to be of different length for each runner but should encompass certain key components. Today's blog post will focus onone component, stretching. So, get that chocolate milk down the hatch, wipe that salt off your face, and listen up!

Believe it or not, getting over muscle soreness after a marathon is not about complete rest. In fact, research has shown that recovery is quickest in those athletes who engage in an active recovery. What this means is that the runner is engaging in very low intensity exercise to enhance blood flow with minimal impact to the body which has been recently stressed. A pool is the ideal environment for this because the pressure of the water boosts bloodflow and the buoancy effect unloads the compression effect of bodyweight. After a brief warm up, like a bout of walking in the pool, or gentle swimming, try some stretching to keep the muscles moving and soft tissue mobile.

Think of stretching in the recovery period as more about recovery than actually having a lengthening effect on the muscles. The goal would be to keep things moving versus making the muscles longer. As a result, a good place to start is on active stretching versus passive stretching. What I mean by this is that runner is taking their legs actively through a range of motion which helps to 'stretch' the legs. Starting with the ankle area, a good example is the seated heel raises and toe lifts, collectively ankle pumping. Pretty simple : from a seated position the runner is raising up onto their toes by lifting their heels off the ground, followed by rocking back onto their heels and lifting the toes off the floor. The pumping effect of this exercise helps to improve blood flow and gently take the ankle through a range of motion that lengthens the muscles. Another good active stretch is performed with the runner on theor back. One leg is flexed up bringing the knee toward the chest. At this point the knee is graps and a gentle amount of overpressure is applied. You can alternate legs x 10 reps. This will keep the posterior hip muscles mobile.
Another example of an active stretch which can be done with a rope is the active assisted hamstring stretch.The rope loop is placed around the bottom of the foot.With the runner lying on their back, the hip is flexed such that the thigh bone is perpendicular to the ground. The runner then tightens their quads such that the knee straightens placing a stretch on the hamstrings. Hold 20 seconds and repeat on both sides. What is great about this stretch, along with others with the rope, is that when the quad contracts, it inhibits the muscle opposite to it, the hamstring. This is called reciprocal inhibition.
The rope can be used to stretch the quads while the runner is on their stomach. It can also be used to stretch the leg actively out to the side, hitting the adductors.

Another useful tool in recovery is a foamroller. These devices can be found in most gyms and running stores(www.runpacers.com). They are an inexpensive tool which is essentially using the runner's bodyweight to compress the muscle tissue. The compression of the muscle tissue can help to enhance mobility of the tissue in a variety of planes. For the runner, two of my favorite uses of the roller are on the iliotibial band and the quads. Both areas take moderate stress with running so the roller can be surprisingly helpful. No special techniques here. I typically recommend rolling back and forth over the involved tissue 10 times. Other target areas include the glutes, the hamstrings, and the calf muscles, pictured below.

Be in touch with questions.....

Tapering

It would seem like half of the DC run community is tapering for fall marathons. With Marine corps, NYC, Philly, and Richmond wedged into about a months time, it is a good time to review the concept and value of tapering.



In essence, tapering refers to a gradual decrease in training volume to allow the body to recover from the months of training load. The reduction in training volume has been documented to result in improved race performance. It is worth mentioning that for a dedicated athlete reducing training volume can be quite difficult. After months of a routine of training, taking it easy ain't so easy! Unfortunatley, I feel that most athletes short change the benefits of their focused training by not tapering enough.



A taper for a marathon typically is two to three weeks in duration. A more experienced runner may be able to get more out of a two week taper than a full three weeks. On average, the last three weeks before a race will see a 20%, 40% and finally a 60% reduction in weekly training volume. It is essential to note that there is a reduction in volume but not intensity. The reason for not reducing intensity is that we want the body to recover from the training but not lose its adaptations from the focused training. The intensity work leading up to race day keeps the body primed to perform at the high level of our race day pace mentally and physically.

Interestingly, three weeks from race day is when most runners overdo it. This leads to feeling flat two weeks out at which point the struggle begins to rest up. A gentle reduction in volume three weeks out helps you feel fresh physically and mentally. I feel that is is usually better to undertrain versus the alternative.



Most marathon training programs have a minimum of three specific components: speed work to influence VO2max, tempo work to address lactate threshold, and a long run for endurance. Each of these components will experience a reduction in volume, not intensity. We all have our favorite training programs because they work for our particular needs and schedule. It is important to underdstand that what works for one runner might be ineffective for another. With experience you can decide how much long of a taper you need, and how much volume you need to reduce.

The last month of training for a marathon look like this for me:
speedwork:10x400,8x800, 5 x 1000, and 6x400 race week (all with warm up and cool down)
tempo work:8miles at marathon pace(MP), 5 at mid tempo pace, 10k-3 easy/3 hard, 3@MP
long runs:20mi at MP+15sec, 13 @MP, 10@MP, Race day!

These are the key components of my runs. I have some junk miles and plenty of cross training sprinkled in there. This gives you a starting point. Keeping a training log helps you go back to review patterns when you have a good race. More importantly, when you have a bad race you can actively avoid what might have lead you down that path.

Happy trails.....

Grindstone

It is still hard to believe that two weeks ago I ran 100 miles. I have done a dozen or so ultramarathons, and numerous endurance multi sport events, but this one takes the cake by a long shot. As hokie as it sounds, I look back on it almost like it was an out of body experience. Even though it took me over 25 hours to complete the course, the days seems like a blur.

My buddy Bill Potts did the race also. We were both 'first timers' to the hundred mile distance. What this really means is that we are stupid enough to have raced half that distance many times and now thought we were 'ready' to bridge up to the true gold standard for an ultra runner. We were not exactly wrong to think this, but I look back and wonder is a person is even really ready for a 100 consecutive miles. What we larned was that it is a race of patience, a race ofstarting slow and finishing slower, a race of attrition, and most of all, a race where it is great to have family and friends nearby to support you. Bill and I have agreed countless times since race day that we will look back on the 2009 Grindstone 100 with smiles because of the people who shared it with us: David Mercer, B. Young, Gentry, Julie and The Gillanders Crew, Lisa Potts, Dan, Adam, Clark and so on.

The weekend really started with a bang because we went to the U2 concert in Charlottesville on Thursday night. In hindsight, pulling a 19 hr day before a hundred miler was not the recommended course but as joel said in 'Risky Business' sometimes you just gotta say "what the mailto:f*#@ concert was great and added to the overall experience.

Bill and I towed the pop up camper to Camp Shenandoah, set, checked in , rested, had a panic, and then hit the start line. Off we went at 6pm into the woods whihc were soon dark, foggy, and windy in no particular order. We had run half the course in August going in the opposite direction so it was all new to me. Running at night is quite an experience. Running off road in the dark is just nutty. The headlamps will illuminate the trail but do not give you much in the way of depth perspective. Translated this means that for the first 12 hours of the race I was forever kicking my toes on roots, tripping over rocks, and saving myself from doing a spread eagle on the trail by wrenching my back to stay upright. Ouch.

Aid Stations were placed every 6-8 miles so often you would have a serious amounts of time in between to run with fellow racers and chat. I ran with Elizabeth from NJ, Ben from Nova, and of course Bill Body Potts.

My goal was to get to the half way point in 12 hours which I nailed almost to the minute. Certainly having my buddy david as my crew chief helped immensely. When you are running all night, it is just nice to see a familiar face, and have someone to talk to, even if it is for just a minute. Thanks david.

The Grindstone was an out and back route so when I started on the second half of the course it was started to get light again. I was happy that I made it through the night without getting sleepy. The daylight was welcomed because after the above mentioned tripping/stumbling/bumbling etc, I was ready to see what the heck I was running over.

At the 66 miles mark, Bill and I came into an aid station full of the Gillanders crew. That was awesome! Really got a charge from that. We also picked up our respective pacers- for me that was Bill Young, and for Bill that was a man who needs no first name, Gentry! Between the two of them they had many hundred mile finishes under their belts so we knew that we would be in good hands. I picked up some trekking poles for the last 50km which i knew was going to be hilly. Of course, right, you do not cover 100 miles with 23,000 ft up and 23,000ft down with much that is called 'flat'. Off we went.

We got to mile 80 and I was really starting to feel it. I had been good with eating and drinking but realistically, at a certain point, you get tired. And emotional! At the aid station I had to really work hard to keep it together. It is not a pretty sight to start balling in front of your mom who thinks you are freaking nuts already. So, Julie pepped me up, reminded me that a warrior stays strong to the finish, and off we went.

Lydia Young was feeding us soup, mashed potatos, and mac n cheese to help us move forward over those last 20 miles. I finally settled in around mile 95 and was able to poke my way to the finish with a strong finishing Potts, gentry, and Bill Young.

The grindstone tradition is that you hug the totem pole at the finish and who was I to go against the grain.

As lucid as I was over the previous 25 hrs, the finish was a bit dodgy. I was immediately hypothermic and as goofy as ever. Bother John G helped me get to the showers and back to the camper. It was a lights out almost the instant I hit the bed. That is, after I warmed up and ate a variety of oatmeal, hamburger, chili and whatever Julie was spoon feeding me.

We woke to a beautiful day in the mountains, happy to have finished and earned a buckle. dan made a stellar breakfast which was shared with many smiling faces. After the awards, yeah, Potts first place masters!, we chatted with speedgoat and headed home. Thanks again to all those who supported team bobby potts. We could not have done it without you.

I can't imagine it could have gone much better which perfect for your first 100 milers. Keep your fingers crossed for Western States. We shall ride again!

Core myths

The attached link will direct you to a piece done by the New York Times. It profiles a Canadian PhD named Stuart McGill who has done an extensive amount of research on the lower back. He is an expert on developing exercise programs for people who struggle with lower back pain. I have had the opportunity to be taught by Stuart which I found to be very beneficial. I love the basic point he makes here which is be careful of those who don't know what they don't know. You should strive to always work with rehab professionals and trainers who are using the evidence in the medical research to make decisions regarding exercise and rehab. Sounds simple but you would be surprised. Take the example he uses about core strengthening exercises. He states that the research indicates that certain ab exercises place increased load on the back so why would we knowingly choose them versus another exercise. The classic example is the ball ab crunch. The lower back curve is repeatedly flattened and then arched over the ball. This places stress on the lower back so why not choose an exercise that does not. Certainly with a client that has a history of back issues I am going to avoid this one. Even with clients without back problems I will choose another exercise becuase I know I can challenge them without straining the back. The forward plank is a good example of an alternate exercise. So, take home message is to be mindful of the position of the lower back when challenging the abdominals. Enjoy the video : http://well.blogs.nytimes.com/2009/06/17/core-myths/

Running Knee injuries

When you look at the statistics regarding running injuries, you might start to get to get a bit gun shy. The Bristish Journal of Sports Medicine reported that up to 50% of runners will have an injury during a calendar year which will cause them to either miss or alter training as a result. Pretty staggering statistics when you stop to think about it. So the question is, how do I continue to run, and stay injury free? This task is not as hard as you would think.

Of the most common injuries with running, 50% occur at the knees. Typically, runners get pain in the front of the knee, aka chondromalacia patellae, or lateral knee pain, aka iliotibial band syndrome. Sports medicine research has recently noted consistent trends with injured runners, especially female athletes. Even though a runner is symptomatic at the knee, the contributing deficits are typically found at the hip(http://www.drfisio.com.br/artigo12.pdf). The weakness at the runner's hip allows abnormal movement patterns to develop which strain the knee. The abnormal patterns of movement seen with squatting activity are that thigh bone and knee tend to drift excessively toward the midline of the body, as well as rotating inward(http://www.usc.edu/projects/rehab/private/docs/researchers/powers/8_powers_influence_of_altered.pdf). Instead of the knee staying stacked over the foot, it drifts into a knock knee position such that not only is the kne cap put under abnormal load, but the IT band is chafed by the thigh bone. Chris Powers, a PT at USC, used a real-time MRI to see what was happening at the knee with squatting activity and how it relates to these common injuries. In a nut shell, the weakness of the hip abductors and external rotators, allow for the abnormal movement to occur. Take home message on this is for minimal stress to occur at the knee you need a strong hip.

The emphasis of strength at the hip needs to be focused on the hip abductors and hip external rotators. If you stop to think about this for a moment, it makes perfect sense. It all goes back to specificity of training. What I mean by this is that runners tend to be strong in the muscles that are used with running. However, to prevent running injuries at the knees, a runner needs to do exercises which have them moving in other directions than straight ahead running, like out to the side or into leg rotation, for example.

To work on the hip abductors you can simply lie on your side with your back against a wall and raise the top leg towards the ceiling. Keep the stomach muscles tight and lift the leg only about 12 inches. Use the position against the wall to your advantage- make sure your heels stays in contact with the wall so that you are working the abductors, not substituting with another group of muscles.



A more advanced exercise would be using theraband. Tie theraband around your ankle in standing such that it is tight when your ankles are close together. Standing tall, you are going to side step in one direction keeping the torso 'quiet' so the hip muscles can do the work. If you are moving to the right, make sure you do not drag the left foot when it comes closer to the right. Also, control not only the step away with the right leg, but also the step closer with the left leg. Stepping back and forth multiple times is a great way to start. Remember to focus on your posture so the hips are doing the work, not the trunk muscles. Using a mirror tends to be very helpful.


To isolate the hip external rotators is just as easy as the hip abductors. Start against the wall as above. This time you should start by bending the hips and knees such that there is a 90 degree bend in each. Next step is to brace with the stomach muscles as you lift just the top knee up 10 inches. I call this one the 'clam ' exercise. Again, use the wall to your advantage- the wall will prevent you from rotating the pelvis back thereby using the trunk muscles versus just the hip. To make this exercise more challenging, you can wrap the theraband around the knees such that you now have a resisted 'clam' movement. Lift the top knee up, pause, then slowly lower down to the other knee.


Both exercises should be done to fatigue The focus needs to be on form and controlling the movements. I ask athletes to perform 2 sets of 15-20 repetitions. With the straight leg raise against the wall, an ankle weight can be added to increase the challenge. This is also the case with the clam exercise. Theraband, available at running stores like Pacers (http://www.runpacers.com/), can be used once a runner has developed proficiency with the basic level exercises. The theraband would be placed just above the knees for the clam exercise. Again, the focus is one good form with low level resistance and high repetitions.

The G Method

I had a great time talking reccently to a group of runners at The Water Street Gym, my home turf where I practice physical therapy. After giving talks throughout the DC area in 2009, I was happy to show people the gym. The location is great, being in the heart of Georgetown right by the capital crescent trail. Thanks to all for coming to support my efforts to educate the DC running community.
For those of you who could not make it, I will make an effort to recap the finer points, less the coffee and bagels. So, to start, I think it is important to consider the fact that most of us don't really think about running, we just do it. I will admit that runners DO think about where they are going to run, how far they are going, what they are going to wear, the weather, and who they will be running with. Unfortunately, most runners DON'T think about how they are running: their posture, their cadence, their foot placement, or minimizing their ground reaction forces, or how hard their foot is hitting the ground. Being mindful about these core elements of running is the essence of what I have affectionately dubbed 'the G method'. There are many styles of running- Chi, POSE, and Evolution to name a few. These styles overlap one another in many ways. The 'G method' is different because it adds to the mix my experience as a physical therapist. I have seen countless injured runners in the clinic with a variety form faluts. This includes the fast and the slow, the elite and the weekend warrior, the sub 2:20 and the sub five hour marathoners. Although there a range of injuries, and a range of form faults, I do see some consistent patterns which would be helpful to review.

1) Overall Posture: To start, we have to consider the overall posture of running. It is important to stay relaxed, but engaged and focused. By 'relaxed' I do not mean floppy relaxed but rather avoiding unnecessary tension while running which tends to be counterproductive as far as efficiency goes. Instead of clinching fists and keeping elbows flexed up like a boxer waiting to strike, keep a light contact between the thumb and forefinger and the elbows should be flexed to 90 degrees as the arm swings forward and back. Avoid the hands crossing midline of the body. Remember that the arms drive the turnover of the legs which is key to maintaining a high cadence. A high cadence is what has been found to be most efficient. The same forward and back pattern exist for the knees. Make sure the knees are not hitting each time the leg advances forward. Seems pretty simple, but you would be surprised by the number of people who bang their knees together and clank their ankles each time they swing their leg forward.

When talking about posture with runners, I encourage them to run "tall". Think about a string attached to the top of the head which is pulling you upward. Liken the feeling to when you catch yourself slouched in front of your laptop and you reset yourself to an upright position. You might find when you do this the breastbone elevates, shoulders come back, and you feel the abdominal muscles spontaneously kick in. In fact, I ask runners to add to the concept of running 'tall' a low level bracing of the core muscles. Ideally you are just keeping the core muscles awake. You are not holding your breath with some huge contraction, but rather activating them. The purpose behind this is to create a stable base. Without activating the core muscles, the legs do not have a solid foundation to push off of. A stable base from an active core is a key part of the postural component of running. Starting with a stable base gives a runner the greatest potential for efficiency.

2) Foot Placement- Another consistent fault I see with runners is overstriding. Overstriding occurs when the runner's initial contact with the ground is in front of the center of gravity versus below it. In other words, the runner's heel strikes the ground in front of their body versus beneath it. Conceptually, think about this as 'braking' because the runner's forward momentum is being impeded by the ground reaction forces of the heel striking the ground in front of them ( think about Fred Flintstone slowly down his car).

Really what we are talking about is plain physics. The runner is moving in one direction with a goal, typically, of moving swiftly. Thus, we do not want a running form , like overstriding, which is going to slow down the forward momentum. Believe it or not, this actually happens, quite often. The runner strikes the ground with their heel, with their knee nearly straight. The vector of the ground reaction force goes opposite to their forward momentum. Contrast this style of the foot hitting the ground in front of the runner with the knee straight, to the runner who hits the ground below their pelvis with the knee flexed. The second runner is allowing themselves to move forward without disruption of their momentum. Do you want to take a guess about who is going to get there with less energy expended? You got it, the "understrider"!

3) Cadence- Another issue I suggest runners think about is their cadence, or the number of times they are striking the ground per minute. The standard measure is counting the number of heel strikes on one side per minute. The most efficient runners strike the ground at close to 90 strikes per side per minute. Now before you go running off the side of your favorite trail because you are looking at your watch and counting steps, let me give you a tip: start by using a treadmill. Count your steps on one side for 15 seconds and mulitple by 4. You might be surprised by your result. I commonly see people in the mid 70's versus 90 heel strikes per minute. The reason this is important is because we want the foot in contact with the ground for the least amount of time possible. A slow cadence means more time on the ground, more force coming up the leg, and ultimately greater injury potential. Ouch.

It is important to recognize that the cadence of 90 is not specific to a certain speed. Your turn over should remain high regardless of you running slow or fast. What changes from a 9 minute mile pace to a 5 minute pace is that my stride length is changing. The faster I get, the more ground I am covering with each stride. Ideally, my cadence is consistent. Think about your cadence when you are just starting your run. You will really have to work on keeping your cadence up. As your pace begins to quicken focus on letting your leg extend back as your stride increases. When you are running outside, I think the easiest way to keep track of cadence is a digital watch. Glance down at your watch and begin counting when you hit the double zeros. Count heel strikes on one side until you get to 22. Look back at your watch and hopefully you are seeing 15. I doubt you will see a number less than this unless you are the looney tunes roadrunner. Chances are that when you get to 22 strikes on one side you are above the 15 second threshold. Your goal then becomes to try to inch down the time it takes you to get to 22 strikes per side. Think less about chopping your stride short versus just picking up your turn-over. Consciously think about a being quick on your feet, and quick off.

4) Run Softly- Thanks to Irene davis for putting in some great research on running injuries. Irene is a physical therapist at the University of Delaware. One notable study she spearheaded was on stress fractures in runners. What she found with respect to ground reaction forces was that running shoes can decrease the amount of the force by 10%. More importantly, she found that when a runner is asked to consciously tries to decrease the ground reaction force by running 'softly' the forces were lessened by 50%! http://www.udel.edu/PR/Messenger/06/03/Rrunning.html

To me this study is huge. It clearly shows the value of being mindful of your run form, especially how you run. Thinks about being light on your feet. Try to land as softly as possible. I encourage runners to really listen to how they are striking the ground. Does the impact of one foot make a louder noise than the other? If so, can you balance it out? Also, when you are running on a trail like the C and O towpath, can you run so softly that you are sneaking up on your fellow runners bacause you are so quiet. You can apply these principles to your cross training too. Try being quiet and soft when you are jumping rope, for example.

CONCLUSION: For most of us, we learned to run as kids when we were chasing a soccer ball, or fleeing from a friend or sibling. The reality is that as we grow older we need to be mindful of how we are actually moving when we run. This will help to enhance efficiency and decrease the risk of injury which is inherent to running. There are many key components of running form which are typically best addressed with a run coach, or physical therapist, who can determine what you individually need to work on. Listed above are common faults which, when properly applied, can lead to meaningful changes in run economy. When this happens, the runner typically sees a bump in performance. Good luck and if interested in a running evaluation, including video analysis, be in touch!

robertgillanders@yahoo.com

Ergo what?

Posture is hugely important in the 'G method' running style, which is my addition to the whole running form paradigm . Obviously this includes posture while running, but more importantly, posture when not running. It makes sense that if most of us are running just a small percentage of our daylight hours, the activity and posture the rest of the time is probably equally or more important to think about. When I work with a runner who is in front of a computer all day, I know that if they have slouched posture it is going to influence their overall posture while running too. So, let's talk about ergonomics for a moment. (For the record, via the Back School of Atlanta, I am a Certified Ergonomics Specialist). Ergonomics is the science of adapting a workplace to fit the worker. I will address the needs of the basic desk jockey and how you can be more mindful of your desk set-up.

First off, there is no such thing as perfect posture which can be used all day long. A key part of desk posture is the concept of taking frequent breaks so the postural muscles get a change from the constant stress of being in one position. Though not commonplace, I feel the advantages of having a standing desk are enourmous. I digress. Relate this concept of frequent breaks to the Galloway method of marathoning. This method of running inserts bouts of walking into long runs to give the running muscles a break. At the desk, think of taking a break every 30-40 miutes to stand, or stretch or both. This will hit the reset button on your muscles. In the long term they will thank you for this. With regular breaks, muscles are less inclined to become irritated because they are not stressed for such a long duration.

Create a mental checklist for your desk posture by thinking about your posture from the ground up: feet are flat on the floor (use a box or book to rest you feet on if your feet don't reach the floor), your knees are flexed to 90 degrees, your hips are flexed to 90 degrees ( or slightly higher than the knees if that is more comfortable), elbows are flexed to 90 degrees AND forearms resting on armrests! To me this is a key element- don't let the weight of your arm and gravity pull your shoulders down. This places stress on the lower part of your neck because many of the muscles that attach to the shoulder blade connect to the neck. Because of this connection, when the shoulders hang down unsupported it creates compression on the neck. Needless to say, the discs in your neck do not like this. Support your forearms such that their weight is neutralized because the armrests are doing the work of holding them.

Continuing to move up the body, you want to make sure your shoulder blades are tucked back towards the spine. Recognize that when you slouch not only does your neck poke out like a turtle but your shoulders round forward and the shoulder blade pulls away from the spine.

This allows the front of the shoulders to get tight, the mid back to get stiff, and the neck to stress. So, keep those shoulder blades back as you sit up tall. The posture of the neck should be tall. Think about someone pulling you up by a string attached to the top of your head. Your chin should be gently tucked down toward you adam's apple.

Another important element is making sure your lower back is supported. There are all kinds of products out there for this if your chair does not have it built in to it. A reasonable place to start is taking a towel and rolling it up like a tootsie roll and placing it behind the lower back. The goal is to maintain the normal curve in your lower back. It should snugly cradle your back so that you do not fall back into the chair. However, the roll should not be so big that it pushes you forward into an excessively arched position.

The above comments talk about the posture of the worker but let's focus a bit more on the desk set up. Think about your set up facilitating continued upright posture. For example, a monitor that is too low is going to facilitate slouching. A monitor that is at eye level will encourage the person to stay in a more upright position. The same could be said about a keyboard- too far away encourages slouching. Keep the keyboard and mouse close so you do not have to reach out for them. When your forearm is supported, and the elbow is at 90 degrees, the keyboard should be right there for you.

A laptop presents some challenges. If the monitor is at eye level, then you have to reach for the keyboard. If the keyboard is in reach, typically the monitor is out of place. I usually suggest that a person invests in a plug in keyboard so they can have it close by while the monitor is raised to eye level. You would also need a plug in keyboard to make it work.

To review, have a desk set-up that encourages good posture: the chairs is high enough for feet to be flat, knees and hips at 90 degrees of bend. The forearms are supported with the elbows at 90 degrees. The keyboard and mouse are within immediate reach, monitor is at eye level. Overall posture is just like mom wanted- upright and tall!

Not sure your set-up is right? Take a picture of you at your workstation and email it to me. I would be happy to give some feedback......

T

local press

I have had the opportunity to work with some pretty special clients over the past dozen years as a physical therapist. One such person lately has been Wilson Komen. Wilson is a local marathoner and aspiring running coach (http://www.coachkomen.com/). His street cred as a runner is solid. I would say you achieve this status when you run a sub 2:20 marathon. And certainly when you do that multiple times, well even better. Wilson came to me during a transition period. He was recovering from a leg injury which he felt had hindered him from running at his full potential for longer than it should have. I notice right away that for as fast as he was, that Wilson had lots of room to grow with his strength. His core strength and hip strength were hardly in line with his world class speed. So, for the past few months Wilson and I have set out to change this. Once or twice a week we work out together with a focus on exercises for running. To me this means an emphasis on leg and core strengthening. I started him with double leg exercises, like a basic squat. As he has become stronger, I have challenged him with single leg exercises. Next in the progression will be using unstable surfaces. I use this progression with all of my runing clients: groove the motion double leg, challenge the motion single leg, see what you are made of on an unstable surface.

One point of emphasis with Wilson is to always control his patterns of movements with the exercise. This enables him to dictate alignment of his leg and overall posture. This focus allows him to isolate the muscles we want to strengthen, and minimize substitution patterns. When he first came to me he ran with form which allowed him to compensate for his hip weakness. See the video below which provides footage of Wilson running. From the posterior view you can see how much he shifts his shoulders side to side. If you are having difficulty seeing it, watch his head relative to the pipes which are above him. The reason he moves so much with his shoulders is because his hips can't hold his pelvis level so he has figured out how to compensate. While he has used this style of running to run incredible fast, my thought is that if he wastes less energy side to side he will have more to propel himself forward. A more efficient running style means a faster Wilson. Our goal is fir him to run a 2:15 at Baltimore in the fall. Go Wilson go! Attached is a link to a recent article about our efforts.
http://www.examiner.com/examiner/x-8091-DC-Running-Fitness-Examiner~y2009m7d15-Never-get-hurt-Georgetown-physical-therpist-on-injuryprevention-for-runners

Highland Sky 2009

Someone told me that Highland Sky is a 40 miler that runs like a 50 miler. Not sure what that means other than is is one mutha of a race. It has so much variety as far as terrain goes: tons of single track, rocks, streams, expansive views of wilderness, hills, endless forest roads, boulder fields...you name it! This was the second time I was brave enough to toe the line in Canaan. Highland sky is the premier club race of the West Virginia Mountain trail runners (http://www.wvmtr.org/). For me, as a long time member, it is fun to plan a weekend around seeing friends and jamming out a butt kicking trail run. We had two miles of a warm up before the rains started. After that, it was pretty much a sog fest. The deluge caused the single track to become more of a canal. The problem with this is that the course is so rocky that you never knew what the next step would bring. One step would be into 6in of mud, the next right on top of a rock. Guess I was happy to get out of there without serious injury. I tried to run up on the scrub brush but after wiping out hard twice from tripping over a stump, I decided to fjord the canal as best I could.

One thing I noticed about HS '09 was that my speed on the road section was much improved. I attribute this to more consistent speed work this training year. After running only 3 days a week for many years, I added a fourth day. It allowed me to do more speed work. As crazy as it sounds, to run fast you have to train fast. The track work is key, as are the tempo runs. I have regrouped with some local fast guys who push me to run faster than I would myself. They also train very hard in the gym which is vital. Thanks Nick and Roo.

In the gym, I personally try to focus on hip and core strength, balance, and big muscle movements. From my work as a PT I know how important these areas are. The balance work really pays off in a race like highland sky. Even the most basic exercise, like a biceps curl, I try to do on the BOSU in single leg standing. Exercises like single leg squatting on a BOSU really play into the running motions. I find the single leg work trains the supportive muscles of the foot and ankle which can really take a beating in an ultra. More to follow on the running exercises.

Back to the race, I made it through the rain, the wind, the shoe sucking mud, and finally the "butt slide". Not sure who coined this name but it refers to a descent off Timberline ski resort which is steep and fall inducing, especially in the mud. It was a walk down memory lane for me as it is one of the descents featured in the 24 hours of Canaan mountain bike race I did in 1995. As I was picking my way down the 'slide, I recalled how I had gone ass over teakettle on my hardtail Rocky Mountain about 12 years prior. Pretty funny. So I flogged my way to the finish trimming 50 minutes off my last Highland sky in 2007. The best part was feeling mentally strong. I will need that come October when I toe the line at Grindstone (http://www.eco-xsports.com/grindstone.php).

Very cool. The post race beers were great, as has been the 8 days off of running. I am looking forward to the 4th of July and coming back to the training with a spring in my step and much focus. Keep 'em waffle side down, G.