The Kettlebell March Drill for Functional Core Stability

We’re big fans of farmer carries and suitcase carries at Champion.

Carries do a great job of developing functional core stability by adding an offset weight to the center of rotation of the body. But carries also offer so many other benefits – from grip strength, to upper body development, to overall athleticism.

Often times, clients with poor core strength or control will compensate during the carry.

If the core can not stabilize the trunk with the added load of the carry, it will compensate by relying on the static stabilizers of the body and rocking back into hyperextension of the back or leaning to the side.

In the below video, Kiefer Lammi, our Director of Fitness at Champion, shows how we have started to modify the carry in these individuals by adding a march. Not only does this promote better core control, it also facilitates training the trunk to remain stable while the distal extremities move functionally. This is one of the fundamental principles to enhance how well people move and perform.

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5 Reasons Why I Don’t Use the Sleeper Stretch and Why You Shouldn’t Either

Ah, the sleeper stretch.  Pretty popular right now, huh, especially in baseball players?  Seems like a ton of people are preaching the use of the sleeper stretch and why everyone needs to use it.  It’s so popular now that physicians are asking for it specifically.

I don’t like the sleeper stretch and I rarely use it, in fact I haven’t used it in years.  I don’t think you should use it either.

There, I said it, I felt like I really had the get that off my chest!

Every meeting I go to, I see more and more people talking like the sleeper stretch is the next great king of all exercises.  Then I get up there and say I don’t use it and everyone looks at me like I have two heads!  Call me crazy, but I think we probably shouldn’t be using it as much as we do.

In fact, I actually think it causes more harm than good.

 

5 Reasons Why Shouldn’t Use the Sleeper Stretch

I haven’t used the sleeper stretch in over a decade and have no issues restoring and maintaining shoulder internal rotation in my athletes with safer and more effective techniques.

If you have followed me for some time, you know that I rarely talk in definitive terms, as I always strive to continue to learn and grow.  I know my opinions will change and things aren’t black and white.  However, over the years my stance on NOT using the sleeper stretch has only strengthening.  As I learn more and grow, I actually feel more strongly that we shouldn’t be using this common stretch.

So why don’t I use the sleeper stretch?  There are actually several reasons.

 

It’s Often Performed for the Wrong Reason

The sleeper stretch is most often recommended for people with a loss of shoulder internal rotation.  When a person has a loss of internal rotation, it can be from several reasons, including:

  1. Soft tissue / muscular tightness
  2. Joint capsular tightness
  3. Joint and boney alignment of the glenohumeral joint and scapulothoracic joint
  4. Boney adaptations to repetitive tasks, such as throwing a baseball and other overhead sports

You must assess the true cause of loss of shoulder motion and treat accordingly.

Of the above reasons, you could argue that only joint capsular tightness would be an indication to perform the posterior capsule.  But see my next point below…

Performing the sleeper stretch for the other reasons could lead to more issues, especially in the case of boney adaptations.  The whole concept of glenohumeral internal rotation deficit (GIRD), is often flawed due to a lack of understanding of the normal boney adaptations in overhead athletes.

I can’t tell you how many people think they have GIRD that I evaluate and that they in fact do NOT have GIRD.  Click here to learn more about how I define GIRD.

 

It Stretches the Posterior Capsule

If you have heard me speak at any of my live or online courses, you know that I am not a believer in posterior capsule tightness in overhead athletes.  Maybe it happens, but I have to admit I rarely (if ever) see it.  In fact, I see way more issues with posterior instability.  Please keep in mind I am talking about athletes.  Not older individuals and not people postoperative.  They can absolutely have a tight posterior capsule.

But for athletes, the last thing I want to do is make an already loose athlete looser by stretching a structure that is so thin and weak, yet so important in shoulder stability.

Urayama et al in JSES have shown that stretching the shoulder into internal rotation at 90 degrees of abduction in the scapular plane does not strain the posterior capsule.  However, by performing internal rotation at 90 degrees of abduction in the sagittal plane, like the sleeper stretch position, places significantly more strain on the posterior capsule.

Based on the first two points I’ve made so far, if you have a loss of shoulder internal rotation, you should never blindly assume you have a tight posterior capsule.

Assess, don’t assume.

But be sure you know how to accurately assess the posterior capsule.  Many people perform it incorrectly.  Click here to read how to assess for a tight posterior capsule.

 

It is an Impingement Position

This one cracks me, check out the photos below, if you rotate a photo of the Hawkins-Kennedy impingement test 90 degrees it looks just like a sleeper stretch.  I personally try to avoid recreating provocative special tests as exercises.

sleeper stretch impingement reinold

 

This is a provocative test for a reason, by performing internal rotation in this position, you impinge the rotator cuff and biceps tendon along the coracoacromial arch.  If you actually had a tight posterior capsule, you’d get subsequent translation anteriorly during this stretch and further impingement the structures.

So based on this, even if you have a tight posterior capsule, I wouldn’t use the sleeper stretch.  I would just perform joint mobilizations in a neutral plane.

 

People Often Perform with Poor Technique

So far we’ve essentially said that people often perform the sleeper stretch for the wrong reasons and can end up torquing the wrong structure (the posterior capsule) and irritating more structures (the rotator cuff and biceps tendon).

Even if you have the right person with the right indication, the sleeper stretch is also often performed with poor technique, which can be equally as disadvantageous.

People often roll too far over onto their shoulder or start in the wrong position.  If you are going to perform the sleeper stretch, at least follow my recommendations on the correct way to perform the sleeper stretch.

 

People Get WAY too Aggressive

Despite the above reasons, this may actually be the biggest reason that I don’t use the sleeper stretch – people just get way too aggressive with the stretch.  The whole “more is better” thought process.  Being too aggressive is only going to cause more strain on the posterior capsule and more impingement.  You may actually flare up the shoulder instead of make it better.

I always say, if you have a loss of joint mobility, torquing into that loss of mobility aggressively is only going to make it worse.

 

When the Sleeper Stretch is Appropriate

There are times when the sleeper stretch is probably appropriate.  But it’s not as often as you think and it’s most often not in athletes.  The older individual with adhesive capsulitis or a postoperative stiff shoulder may be good candidates for the sleeper stretch.  But I honestly still don’t use it in these populations.  There are better things to do.

But of course, there are good ways to perform the sleeper stretch and there are bad ways, technique is important.

For more information on some alternatives to the sleeper stretch, check out my article on sleeper stretch alternatives.

 

How do SLAP Tears Occur: Mechanisms of Injury to the Superior Labrum

**Updated in 2017**

How does a SLAP Tear of the shoulder occur?

That’s a common question I here often.  Now that we have discussed the different types and classification of SLAP tears to the superior labrum, I wanted to now talk about how these shoulder injuries occur. There are several injury mechanisms that are speculated to be responsible for creating a SLAP lesion. These mechanisms range from single traumatic events to repetitive microtraumatic injuries.

This article is part of a 4-part series on SLAP Lesions

 

Traumatic SLAP Injuries

mechanism of slap tearTraumatic events, such as falling on an outstretched arm or bracing oneself during a motor vehicle accident, may result in a SLAP lesion due to compression of the superior joint surfaces superimposed with subluxation of the humeral head. Snyder referred to this as a pinching mechanism of injury. Other traumatic injury mechanisms include direct blows, falling onto the point of the shoulder, and forceful traction injuries of the upper extremity.

To be honest with you, I don’t know if this is actually the underlying cause of the SLAP lesion. I have questioned this theory in the past and don’t know the answer, but part of me at least wonders if these patients already had a certain degree of pathology to their superior labrum and the acute injury led to a MRI and diagnosis of a SLAP tear.

Essentially the MRI may have found an old SLAP tear.

 

Repetitive Overhead Activities

Repetitive overhead activity, such as throwing a baseball and other overhead sports, is another common mechanism of injury frequently responsible for producing SLAP injuries.

This is the type of SLAP lesion that we most often see in our athletes. In 1985, Dr. Andrews first hypothesized that SLAP pathology in overhead throwing athletes was the result of the high eccentric activity of the biceps brachii during the arm deceleration and follow-through phases of the overhead throw. To determine this, they applied electrical stimulation to the biceps during arthroscopic evaluation and noted that the biceps contraction raised the labrum off of the glenoid rim.

Peel Back SLAP Tear

Burkhart and Morgan have since hypothesized a “peel back” mechanism that produces SLAP lesion in the overhead athlete. They suggest that when the shoulder is placed in a position of abduction and maximal external rotation, the rotation produces a twist at the base of the biceps, transmitting torsional force to the anchor.

This mechanism has received a lot of attention and several studies seem to show its accuracy.

Pradham measured superior labral strain in a cadaveric model during each phase of the throwing motion. They noted that increased superior labral strain occurred during the late-cocking phase of throwing.

Another study from ASMI simulated each of these mechanisms using cadaveric models. Nine pairs of cadaveric shoulders were loaded to biceps anchor complex failure in either a position of simulated in-line loading (similar to the deceleration phase of throwing) or simulated peel back mechanism (similar to the cocking phase of overhead throwing). Results showed that 7 of 8 of the in-line loading group failed in the midsubstance of the biceps tendon with 1 of 8 fracturing at the supraglenoid tubercle. However, all 8 of the simulated peel back group failures resulted in a type II SLAP lesion. The ultimate strength of the biceps anchor was significantly different when the 2 loading techniques were compared. The biceps anchor demonstrated significantly higher ultimate strength with the in-line loading (508 N) as opposed to the ultimate strength seen during the peel back loading mechanism (202 N).

You can see photos of the study below.  The first photo is a normal glenoid with the labrum and attaching long head of the biceps.  The second photo is the simulation of the traction and eccentric biceps contraction.  The final photo is simulation of the peel-back lesion.

In theory, SLAP lesions most likely occur in overhead athletes from a combination of these 2 previously described forces. The eccentric biceps activity during deceleration may serve to weaken the biceps-labrum complex, while the torsional peel back force may result in the posterosuperior detachment of the labral anchor.

 

 

shoulder seminarLearn Exactly How I Evaluate and Treat the Shoulder

If you want to learn even more about the shoulder, my online course at ShoulderSeminar.com will teach you exactly how I evaluate and treat the shoulder.  It is packed with tons of educational content that will help you master the shoulder, including detailed information on the clinical examination and treatment of SLAP tears.

 

 

 

5 Ways to Decrease the Risk for an ACL Injury

Injuries to the Anterior Cruciate Ligament (ACL) are some of the most common injuries in the active population. As incidence of other injuries have decreased, injuries involving the ACL have rose astronomically over the years.  There have been numerous studies done looking at what causes the ACL to tear. More specifically, female athletes are 4-5x more likely to tear their ACL as compared to their male counterparts.

Like with any injury, it cannot be blamed on one thing. Injuries are multi-factorial as well as non-preventable.  Injuries will always happen.  The only thing that we can do is to decrease the frequency or incidence of them. Luckily, as we continue to learn more about the mechanism of injury, we have developed some strategies to reduce your chance of ACL injuries.

 

5 Ways to Decrease the Risk for an ACL Injury

Here are 5 things to focus on when designing programs to reduce ACL injuries.

 

Optimize Mobility

If you look at the human body, there are many joints. Some of those joints require mobility and some of those joints require stability. Depending on which plane of motion you are in, mobility or stability is usually more imperative than the other.

When it comes to mobility, there are certain joints in the body that we need to have optimal mobility in order to decrease the risk for an injury to the ACL. The two joints that come to mind are the talocrural joint of the ankle, and the femoroacetabular joint of the hip.

For the ankle, specifically dorsiflexion range of motion is imperative to decrease strain at the knee. If the ankle doesn’t have the ability to dorsiflex and absorb force during a land from a jump or cutting maneuver, the mid foot or knee are the two joints that will have to have increased mobility to accommodate the athletic endeavor.

 

Ankle Mobility

To assess for adequate ankle mobility, use the Knee to Wall Ankle Mobility Test.

Key Points:

  • Place your foot 4 inches away.
  • Keeping your foot flat on the floor, attempt to touch your knee to the wall.
  • Don’t allow for valgus or varus collapse.

If you can reach the wall from 4 inches, then you have sufficient ankle mobility to run, squat, and perform without playing increased stress through the knee due to poor ankle mobility.

The other joint in the body that needs to have optimal mobility is the hip.  The motions at the hip that need adequate mobility are hip flexion, hip extension, hip abduction, hip internal and external rotation.

Now, you may be saying, “Wow, that’s a lot of areas that need mobility.”  Well, let’s break it down!

 

Hip Flexion

5 ways to reduce ACL injuriesAnecdotally, I like to see clients present with full hip flexion. If there is decreased mobility into hip flexion, this can send a signal to the brain to alter movement and muscle firing patterns and in turn, can affect how someone lands or moves.

A quick and easy test is to test passive hip flexion range of motion.  

This involves bringing your knee towards your chest. Ideally, your thigh should reach the inferior aspect of your rib cage. Now, everyone is made differently and depending upon what sport you play, hip structure can vary from person to person.

If you cannot reach your thigh to your rib cage, slightly abduct your thigh and see if you can go further. If you can, then your hips are structured a little differently.

 

Hip Extension

Key Points:

  • Thigh should be able to reach parallel to ground.
  • Knee should be at 90 degrees to thigh.
  • Thigh should drop straight down and not flare out towards side of body.

Hip extension mobility is necessary to be able to activate the gluteus maximus and hamstrings in order to decrease incidence of a valgus collapse. If adequate hip extension mobility is not present, then muscular compensation will occur and in turn, possible injury.

 

Hip Internal Rotation (IR)

Even though hip internal rotation is part of the combination of movements that contribute to an ACL injury, not having the requisite mobility is a risk factor. If the body doesn’t have certain available ranges of motion, then the brain and central nervous system are not able to prevent going into those said ranges of motion. Therefore, if someone doesn’t have adequate hip internal rotation, then the body has no way to prevent that motion from occurring.

VandenBerg et al. in Arthroscopy: The Journal of Arthroscopic & Related Surgery that “risk of ACL injury is associated with restricted hip IR, and as hip IR increases, the odds of having an ACL tear decreases.”

 

Hip External Rotation

Hip external rotation is important because avoidance of a knee valgus position is necessary to avoid injury to the ACL. Having adequate hip external range of motion will allow the athlete to be able to get into an athletic position to avoid that valgus position.

 

Learn How to Land

You watch any NFL or NBA game and guys are jumping to catch a ball to to tap in a rebound for 2 points. Most injuries to the ACL don’t occur on the jumping portion as it does on the landing portion.

When athletes have to land from a jump, the body has to absorb 7-10x their body-weight in forces from the ground.  If joints aren’t in an ideal position to absorb and adapt to stress, injuries can happen.

landing mechanics ACL injury

Photo credit

Therefore, we need to assess athletes in their landing patterns and mechanics to make sure their body is resilient and capable to land properly.

 

Step Down Test

 

The Step Down Test is a simple way to determine an athlete’s predisposition to absorbing eccentric stress. Ideally, we like to see the pelvis, hip, knee, and ankle remain in a line during descent.

 

If someone steps down and the femur internally rotates and the knee goes into valgus collapse,  this is something that needs to be rectified.

If you want to use a more quantitative analysis of landing mechanics and skill as compared to the contralateral limb, then here are 3 tests that can help with that.

 

Single Leg Hop for Distance

Key Points:

  • Instruct the athlete to jump as far as then can and land on 1 leg.
  • They must stick the landing without hopping around or using their leg/arm for balance.
  • Perform 2 trials.  Measure each jump, take the average of the 2 trials, then repeat on the opposite leg.

 

Triple Hop for Distance

Key Points:

  • Instruct the athlete to jump as far as they can, land on 1 leg, and continue for 2 more hops, sticking the 3rd landing
  • They must stick the landing without hopping around or using their leg/arm for balance.
  • Perform 2 trials.  Measure each jump, take the average, then repeat on the opposite leg.

 

Crossover Hop for Distance

Key Points:

  • Instruct the athlete to jump as far as they can, land on 1 leg, and continue for 2 more hops, sticking the 3rd landing while crossing over a tape line on the floor with each jump.
  • They must stick the landing without hopping around or using their leg/arm for balance.
  • Perform 2 trials.  Measure each jump, find the average, then repeat on the opposite leg.

Now that you have the average for all 3 jumps, we need to determine if the difference between the two limbs is significant. According to Adams in the Journal of Orthopaedic and Sports Physical Therapy, limb symmetry indexes of 90% have previously been suggested as the milestone for determining normal limb symmetry in quadriceps strength and functional testing.

According to Phil Plisky, one of the developers of the Y-Balance Test, he advocates that the athlete’s reconstructed lower extremity be within 95% on the non-involved leg.

To determine if distances hopped are significant, the involved limb must be within 90-95% of the non-involved side. If it is less than 90%, then that athlete is at risk for future knee injury.

Using a regimen consisting of single leg plyometrics in the sagittal, frontal, and transverse planes as well as single leg exercises that focus on power development can help to improve any major deficits.

 

Achieve Symmetry

If an athlete presents with a gross asymmetry, their risk for injury can increase 3-17x. Besides using the Hop Tests, one way to assess gross asymmetry is also using the Y-Balance Test.

The Y-Balance Test consists of 3 lower and upper body movements. For the sake of this post, we will be focusing on the lower body. The movements consist of:

y balance test ACL injuries

Photo credit

If there is greater than a 4 cm difference right vs left on the anterior reach (1st picture), this is considered a risk factor for a lower extremity injury.

Smith, Chimera, and Warren found in Medicine and Science in Sports & Exercise that “ANT (anterior)  asymmetry >4 cm was associated with increased risk of noncontact injury.”

If there is greater than a 6 cm difference right vs left on the posteromedial or posterolateral reaches, pictures 2 and 3, then this is considered a risk factor for a lower extremity injury.

Asymmetry is a normal thing.  Everyone from elite level athletes to the average joe has natural asymmetries right vs left. Some asymmetries may not change and some asymmetries may make someone the elite level athlete that they are. Having a relative asymmetry right vs left is ok, but having a gross asymmetry is not.

 

Enhance Core Stability

The core musculature is responsible for providing a stable base for the pelvis, hips, knees, ankles, etc. to function off of in life and in sport. If a stable base is not provided, then it can create instability and injury further down or up the kinetic chain.

Decreased core stability can cause:

  • Pelvic Drop
  • Femoral Internal Rotation
  • Knee Valgus
  • Tibial External Rotation
  • Subtalar Excessive Pronation

All these movements are associated with injuries of the ACL. By stabilizing proximally and providing a stable base for all of the aforementioned areas to work off of, this can decrease the risk for injury.

In order to test for core stability, the Trunk Stability Push-Up (TSPU) by Functional Movement is a good test.

This is a great test to determine if someone can maintain a neutral spine while performing a push-up, but also to determine if they have a base level of core stability to maintain a certain trunk position during life/sport.

If someone cannot maintain a specific trunk position, this doesn’t mean that they have a “weak core.” or weak upper extremities. It means that the athlete doesn’t have the capability to stabilize their core proximally in order to exude force distally.

 

Learn How to Decelerate

Most athletes are fast or at least quick on their feet. The great athletes can speed up and slow down better than anyone. One common risk factor we see with ACL injuries is the inability or subpar ability to be able to decelerate.

What this means is that if someone is going to stop or change direction, they need to have the necessary skills to control their body in space when going from accelerating, to decelerating, and then back to accelerating again.

All fast cars are fast! All really fast cars have great brakes!

In order to assess an athlete’s ability to decelerate, observe how the do with change of direction drills.  For example, movements such as:

 

Sprint/Backpedal w/ Redirection

Lateral Shuffles w/ Redirection

Sprint with 45 Degree Cut

Sprint with 90 Degree Cut

Backpedal, Stop, to 90 Degree Sprint

Backpedal, Stop, to 45 Degree Sprint

All of these various movements test an athlete’s ability to accelerate, decelerate and change directions in all planes of movement. A coach, personal trainer, or physical therapist should be present to provide the athlete with the redirection component. This makes it more random and unpredictable to make sure the athlete can react and move appropriately.

While observing these various change of direction movements, observe the mechanics of the pelvis and lower extremity.

Does the pelvis and hip/knee stay in a relative stable and neutral position when decelerating and stopping?

Does the pelvis and hip/knee go into a valgus collapse during decelerating, stopping, and accelerating phases of movement? Compare these right versus left lower extremities.

If you are having trouble observing these things with the naked eye, film it!  There are apps such as DartFish or Hudl that you can download to film athletes and then you can watch it in slow motion to observe any differences side to side.

If differences are seen in right and left comparison, then work on change of direction drills. When first starting off, start the athlete at ½ or ¼ speed so that they can work on their deceleration, stopping, and accelerating mechanics.

We don’t necessarily want to bombard the athlete with too much information about biomechanics of the lower extremity, but having a basic discussion with them and showing them how they currently move and how you would want them to move safely and more efficiently is ideal.

Then once, then can master ¼ or ½ speed, then increase the speed of the drills until you are working at full speed on both sides. There are a multitude of drills out there to work on acceleration, deceleration, stopping, and change of direction. Make sure start with the sagittal plane, and then progress into the frontal and transverse planes.  

If you can’t master the sagittal plane, then the frontal and transverse planes will be much more challenging.

Assessing mobility, landing mechanics, relative lower extremity symmetry, core stability, and acceleration/deceleration can all help to improve an athlete’s performance as well as decrease their risk for an ACL injury.

 

About the Author

Andrew Millett is a Boston-based physical therapist in the field of orthopedic and sports medicine physical therapy.  He helps to bridge the gap between physical therapy and strength and conditioning.  Visit his website at AndrewMillettPT.com.

 

 

 

A Simple Approach to Running Analysis for Clinicians

This week’s post is an amazing article by my friend Chris Johnson on what he looks for during a running analysis.  Chris is my go-to resource for running related injuries and rehabilitation.  He’s also recently developed an app on the iTunes app store to help runners, which I have reviewed and found to be really impressive.  Check it out at the end of this article!

 

A Simple Approach to Running Analysis For Clinicians

a simple approach to running analysis for cliniciansThe ultimate special test for runners is RUNNING.

For some odd reason, when runners seek medical consultation, clinicians routinely neglect watching them run during the rehab process. While it may not always be appropriate to take an injured runner through a formal running analysis at the time of presentation, at some point it’s imperative to take the time to watch them run. Only then will you gain a more complete understanding of perhaps what landed them in your hands in the first place.

A great deal of research has emerged over the past several years specifically looking at various characteristics of the running gait and their associated implications. A few prime examples include but are not limited to the following:

  •      Footstrike
  •      Step rate
  •      Hip adduction
  •      Loading rates
  •      Speed

By taking the time to understand the running gait along with ways to shift loads in the lower extremity, clinicians will ultimately be in a better position to help runners return to consistent training in a timely manner through manipulating physical loads on the ecosystem.

While this may seem daunting to those new at running analysis, it can actually be quite simple.  The purpose of this post is to provide clinicians with a simple framework to approach conducting a running analysis using what I call “The Four S’s of Running Analysis.”  These are:

  •      Sound
  •      Strike
  •      Step rate
  •      Speed

While it’s important to appreciate that overground and treadmill running are different animals, approaching every running assessment in a systematic manner is important. Clinicians are encouraged to use the resources at their disposal while understanding their relevance and limitations. By developing proficiency in performing a running gait analysis, clinicians will ultimately refine their clinical decision making and improve their outcomes in terms of restoring one’s float phase.

 

Sound

Before you even watch someone run, close your eyes and listen to the sound of their running gait. As clinicians, there is a great deal of information that can be ascertained by simply listening to one run.

  •      Does the runner land quiet, or is does it sound like they are going to put a hole through the ground or treadmill belt?
  •      Do their feet sound similar or is there a strike asymmetry?
  •      Does the sound of their footstrike change as a function of being shod versus unshod?
  •      Does the sound change as a function of different shoe types?

One of the simplest cues to consider in the event that someone is “overstriking” is to simply instruct the runner to “quiet your feet down.” This may be particularly relevant if the goal is to reduce the vertical ground reaction force (vGRF).

It’s important to appreciate that when one does go to quiet down their feet, that they tend to increase the ankle and knee joint excursions. On the other hand, if landing sound increases, so does the vGRF secondary to decreasing ankle joint excursion while increasing the hip joint excursion (Wernli et al. 2016).

It has been the author’s experience that under a shod condition that a rearfoot strike lends itself to reducing the sound of impact whereas when a runner is barefoot that a forefoot strike serves to quiet down the sound of impact through using the triceps surae to dampen the vertical rate of loading (VRL).

 

Strike

Let’s not complicate things! Does the runner land with a noticeable heel strike or forefoot strike, or do they exhibit a midfoot, or “flat-footed” contact? Is their strike symmetrical?

Also, the point in the race or training session we are discussing matters because one’s strike pattern tends to change over the course of the run, especially during competition (Larson et al 2011).

Over the past several years, there was a considerable buzz around forefoot striking as a means to address common running related injuries. This was due in large part to the book “Born to Run,” in conjunction with Daniel Lieberman’s classic manuscript that appeared in Nature (Lieberman et al 2010) coupled with a craze by the mass media.  It should be mentioned that coaches have long used barefoot training as means to incorporate variability into a runner’s program.

Training runners to incorporate a forefoot strike into their training may prove effective some, such as those with tibial stress syndromes, anterior compartment syndrome, and anterior knee pain.  Caution should be exercised in the context of a past medical history remarkable for injuries involving the calf muscle complex, plantar tissues of the foot, and/or metatarsals as it will bias the load to these regions.

On the other hand, if a runner is dealing with an Achilles tendinopathy or recovering from a calf muscle strain, a heel or rearfoot striking strategy would perhaps be indicated as research has shown that such a strategy reduces Achilles tendon force, strain, and strain rate relative to a FFS pattern (Lyght et al. 2016).

In my opinion, one strike pattern is not necessarily superior to others, but rather, that every strike pattern has unique characteristics and implications (Almeida et al 2015) and serves a purpose pending the context and intent.

By taking the time to understand the implications of each strike pattern, clinicians will be better able to understand the potential changes to consider making as a means to shift load to different regions of the lower extremity. As with any change, however, clinicians must be mindful that it should take place in a slow and gradual manner.

Finally, never take a runner’s word if they tell you that they utilize a certain strike pattern as research has shown that a runner’s subjective report of their strike is not necessarily accurate (Bade et al. 2016).

 

Step Rate

Running is largely about rhythm and timing.

It’s therefore no surprise that over the past several years, a considerable amount of research has focused on step rate or what’s more commonly known as cadence as a simple and practical means to address common running injuries.

The idea is that by increasing the number of steps while keeping running velocity constant, a runner can effectively reduce the magnitude of each individual loading cycle despite increasing the total number of loading cycles for a given training session. This ultimately occurs through a reduction in one’s stride length as when step rate and stride length are manipulated independently, the benefits only occur with a reduction in stride length.

runcadence appBecause I think this is so important, I actually developed a cadence app, RunCadence, which is specifically designed to help runners and clinicians apply cadence to rehab and training for runners through the use of accelerometry coupled with a metronome.

Research has shown that increasing one’s step rate by as a little as five percent above preferred while keeping velocity constant can reduce shock absorption at the level of the knee by upwards of 20 percent. Additionally, increasing step rate by 10 percent above preferred significantly reduces peak hip adduction angle as well as peak hip adduction and internal rotation moments (Heiderscheit et al. 2011).

More recently, a study showed that irrespective of whether one utilizes a rearfoot or forefoot strike pattern that increasing one’s cadence by five percent results in lower peak Achilles stress and strain.

Decreasing one’s stride length through step rate manipulation has also been shown to lead to a wider step width with an accompanying decrease in contralateral pelvic drop (CPD), peak hip adduction, peak ankle eversion, as well as peak ITB strain and strain rate (Boyer & Derrick 2015).

Lastly, clinicians should also bear in mind that increasing one’s step rate greater than 10% above preferred while keeping running velocity constant tends to occur at a greater metabolic cost so as they say, “the juice ain’t worth the squeeze.” So at day’s end, remember that the sweet spot is between 5-10% when it comes to increasing cadence based on the current body of literature.

 

Speed

Anytime one discusses running, it’s important that we account for the amount of ground covered in a given time. This is referred to as running velocity, which is the quotient of distance and time.

The typical units that we go by in the United States are min/mile or miles/hour (mph), though most of the world relies on the metric system (m/s or km/hr). So make sure you have a converter bookmarked on your web browser.

Running is typically classified into one of five categories based on speed (Novachek 1998):

  1. Jogging = 2m/s or 4.5mph
  2. Slow running = 3.5m/s or 7.8mph
  3. Medium running = 5m/s or 11mph
  4. Fast running = 7m/s or 15mph
  5. Sprinting = 8m/s or 17.9mph

Additionally, to run faster, a runner must push on the ground more forcefully, more frequently, or a combination thereof (Schache et al 2014).

At speeds < 7m/s the ankle plantarflexors reign supreme as they contribute most significantly to vertical support surfaces and increases in stride length (Dorn et al 2012). At faster speeds, however, the energy sources tend to shift proximal as a means to increase stride frequency in order to increase speed.

The reality is that most runners seeking our services will fall under the category of joggers and slow runners unless one works with speed based running athletes and short course racers.

Once a runner has reached a point in their rehab where they are a candidate to undergo a running analysis, the question naturally becomes, “what speed should we select?” This question is best answered by primarily considering the runner’s pre-injury status along with the severity, region, type of injury, and agreed upon goals.

It’s also essential to clearly identify the runner’s typical training and race intensities to better understand the entry point to having them run as well as the various speeds worth taking them through as part of the analysis.

It should also be mentioned that a thorough running analysis may require a couple sessions to work them up to faster velocities to ensure tolerance to progressive loading. Unfortunately, a common pitfall in the clinic is reluctance, or failure to have runners work up to faster speeds. This invariably leads to a myopic view of one’s running while engendering the potential for hasty clinical reasoning as we transition runners back to training.

In retrospect, running is an activity that has relatively predictable performance demands. By taking the time to develop proficiency in conducting a simple running analysis while applying the research as it relates to shifting loads in the lower extremity, clinicians will be better positioned to help runners return to consistent and healthy training and beyond.

 

Download the RunCadence App

running_cadence_appRunCadence was developed by two physical therapists to help the running community apply step rate to running via real time step rate notification and metronome.
Start using RunCadence to get more in tune with your running. While no shortcuts or “hacks” to running exist, gait retraining using cadence is the next best thing.  Click below to download:

 

 

About the Author
chris_johnson_headshot

Chris Johnson, PT, is the owner of Zeren PT and Performance in Seattle, WA.  In addition to being a highly skilled physical therapist and performance enhancement specialist for runners, Chris is also certified triathlon coach (ITCA), three-time All-American triathlete, two-time Kona Qualifier, and is currently ranked 16th (AG) in the country for long course racing.

Layering The Basics For Optimal Movement

This week’s post comes from my friend and colleague at Champion, Dave Tilley.  Dave is no doubt one of the most impressive up-and-coming PTs out there right now and we are thrilled to have him part of our team at Champion.  In this day and age, I’m seeing more and more students and young professionals skip the basics.  In this post, Dave talks about how he focuses on some of the basics to achieve optimal performance.

 

Layering The Basics For Optimal Movement

Within my first few weeks of working at Champion, I remember one day Mike Reinold said, “Over the years I think people have overcomplicated things a lot. I’m actually trying to get back to the basics, and just do them really well.”

This stuck with me as I reflected back on my first few years coming out of PT school.  After graduating, I dove into a lot of continuing education trying to catch up with all the new information available. I found myself swimming in a ton of really complicated material related to evaluation, treatment, and research concepts.

I think I let myself get into the complex material a little too much, and I found myself missing a lot of basics when working with clients. The more I learn and gain experience, I am finally able to find the balance. Overall, I have drifted back into making sure the basics are done really well before utilizing more complex approaches.

Coming from my gymnastics background, it’s a sport that is built around mastering the basics and revisiting them constantly. The gymnasts I coach do 45 minutes of basics daily in their workout.

The highest-level elite athletes I have worked with do the basics better than anyone else, and this it what makes the sport so hard.

These same high-level athletes tend to be the best compensators on the planet, having nervous systems that “get the job done” even if it means sacrificing tissue health.

When treating them, it often comes down to revisiting basics first. These “basics” include soft tissue or joint mobility, baseline strength, fundamental dynamic control, and more. It’s only once these factors have been addressed that we can start tweaking the complicated variables of program designed, complex movement patterns and high-level performance.

Here are a few “layers” of categories I consider for the maximizing movement, performance, and rehabilitation.

Layering The Basics For Optimal Movement

Performance / Competition Level Basics

  • Does the person have a well-structured program design, which utilizes appropriate work to rest ratios and a periodized model that fits their goals?
  • Does the person understand the basics of nutrition, hydration, sleep, and recovery methods to maximize the training effect from the point above?
  • Is there some form of athlete monitoring (ideally subjective and objective) for understanding what is happening physiologically and psychologically during the training?
  • Does the athlete have tools or strategies for competition planning, stress management, and mental preparedness?

Sport / Skill Level Basics

  • Has the athlete grown up in a sporting environment that allowed a large range of sensory, motor, and movement based fundamentals to develop. With growing rates of early specialization and year-round training, this tends to become and issue in older athletes?
  • Does the athlete understand a large range of fundamental movements  (squat, hinge, run, push, pull, jump, etc) and are they equally represented in the program. As skill specific training increases this may drop off but it should never be completely lost?
  • Do they understand and show the basics of sport specific movements being trained. Examples include fundamental shaping for gymnastics skills, basic mechanics for pitching, or mastery of barbell only clean/snatch movements in Olympic Lifting?

Movement Level Basics

  • Within the skill specific patterns, does the athlete possess the basic movement components required to complete them. Examples for this may include having adequate overhead mobility or squat depth to hit the Olympic lifting positions, having basic lumbopelvic strength during the gymnastics drills, or adequate single leg stability to transfer dynamic force during a baseball pitch?

Joint Level Basics

  • If the basic movement patterns are not demonstrated, we have to work backwards even further to check the joint level basics within each movement pattern.
  • Within the overhead mobility example, does the person show adequate thoracic spine mobility, glenohumeral capsular and soft tissue mobility, underlying scapular or rotator cuff strength, and basic dynamic stability? For the stride mechanics, is there adequate hip, ankle, and great toe mobility present, along with glute strength and internal hip co-contraction to tolerate the high forces being generated?

 

Where to start for checking off the basics depends on the client. It depends on if they are rehabilitation or performance based, their history, and their evaluation.

It’s important to remember these categories are not mutually exclusive. They are very much interactive. If someone is week 1 postoperative from an ACL surgery, I’m not really worried about his or her power clean mechanics just yet. But, I still may be considering sleep, nutrition, hydration, maintaining metabolic capacity, and training the uninvolved areas of the body to optimize their rehabilitation.

A gymnast or athlete who is not injured but comes to me for performance goals, we may spend more time on the skill specific movements and overall training concepts. However, if they are missing some fundamental strength and joint mobility we may consider that within the treatment sessions.

With this said, I do think that reading and trying to understand complicated concepts is important. After all the human body is pretty complex. To make progress in the fields of human movement, I think we need to break down these larger usually more theoretically constructs.

With that said, we have to always remember that basics and foundational concepts will always need to be in place. As people say, a house built on sand is doomed from the beginning. When troubleshooting a client’s lack of progress in training, rather than spending 30 minutes trying to correct their 3 degree tibial internal rotation asymmetry maybe we should consider the fact they averaged 5 hours of sleep and worked 10 hour days last week.

It’s good to take a step back and make sure we have addressed the low hanging fruit before we scale the entire tree. Only once the basics are covered can we start tackling more complex concepts to help optimize their movement or performance. Just a few thoughts from my point of view, but I hope people found this helpful to think about.

 

About the Author

Tilley-Headshot-400-widthDave Tilley, DPT, is a physical therapist at Champion PT and Performance. Dave comes from an extensive gymnastics background, being a former competitive athlete for 18 years and having 12 years of coaching experience. His unique background as a former athlete and current optional level coach gives him a one of a kind approach to the performance and rehabilitation of gymnasts.  Along with his clinical work, Dave is has a website, http://shiftmovementscience.com, that helps teach coaches, athletes, and healthcare providers about optimal performance and injury reduction concepts.

How Neural Tension Influences Hamstring Flexibility

Many people think they have tight hamstrings.  This may be the case for some but there are often times that people feel “tight” but aren’t really tight.

I’ve been playing around with how neural tension influences hamstring flexibility and have been having great results.

Watch this video below, which is a clip from my product Functional Stability Training: Optimizing Movement, to learn more about what I mean.

 

How Neural Tension Influences Hamstring Flexibility

 

Learn Exactly How I Optimize Movement

Want to learn even more about how I optimize movement?  Eric Cressey and I have teamed up on Functional Stability Training: Optimizing Movement, to show you exactly how we both assess, coach, and build programs designed to optimize movement.

Click the button below for more information and to sign up now!

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What Exactly is Optimal Movement Quality?

What exactly does optimal movement quality mean?

Have you ever thought of that?  How do you define “optimal” movement?”  I would argue optimal movement is slightly different for everyone as we are all unique.

However, I usually think of optimal movement as simply two things:

  1. Do the right joints move (and the wrong ones don’t)?
  2. Do the right muscles work (and the wrong ones don’t)?

Simple.

Watch this video below, which is a clip from my product Functional Stability Training: Optimizing Movement, to learn more about what I mean.

 

What is Optimal Movement Quality?

 

Learn Exactly How I Optimize Movement

Want to learn even more about how I optimize movement?  Eric Cressey and I have teamed up on Functional Stability Training: Optimizing Movement, to show you exactly how we both assess, coach, and build programs designed to optimize movement.

Click the button below for more information and to sign up now!

large-learn-more