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.