Thursday, August 31, 2017

Tightness of the Upper Spine and Running Performance

Good mobility through our thoracic spine (upper back) is vital for good spine health. However, the thoracic spine is inherently stiff due to bony anatomy of the spine itself. The ribs, which serves to protect our heart and lungs, also limit thoracic spine mobility. Poor posture and prolong sitting are the typical causes of tightness in the thoracic spine. In my case (and all moms),  the increase demand of caring for JuJu has significantly increase the stiffness of my thoracic spine extremely.


My upper back flexed to play with JuJu.


What does it mean?

Stiffness in the thoracic spine can cause low back, neck and shoulder pain. Limited motion in the thoracic spine forces the adjacent joints to compensate. These joints move more in order to make up for the lack of motion. This can lead to numerous injuries ( we can save this for another post).

In runners, a tight thoracic spine can hinder taking a proper breath and loading the core.
Typically the thoracic spine is stuck in a forward position ( mostly form sitting all day) which limits the body from sitting in a proper upright posture. Proper posture allows the body to take a full inhalation. Try sitting slouched and taking a deep breathe. Now, sit up straight and take a deep breathe. Notice the difference between the two. Being in a slouched position while running will limit your ability to inhale which hinders performance.

L: Pre mobilizations in below video- It was more difficult turning with my upper back. More of my sports bra can be seen. It's also harder to turn my neck. R: Post mobilizations in below video- There is improve mobility in the thoracic spine. My spine is turned making it more difficult to see the back of my sports bra. It is also easier to turn my head.
***BONUS- Look at my left foot. In the left picture it is more flat. In the right picture there is a greater arch. Being able to rotate through the spine helps to transmit forces into the foot to support the arch. 


Having proper rotational mobility also helps to load the core. The arm swings backwards as the leg drives forward. A rotational stretch is then placed on the core. This stretch helps to provide energy to the opposite leg to help drive it forward. When the core is not properly loaded, it places an extra rotational stress to the low back leading to pain. Poor loading of the core can also lead to improper running mechanics contributing to different injuries throughout the body.


The Science

The spine has motions which are coupled. When the spine is straight, side bending one direction will cause a rotation to the same side ( Type 2 motion). When the spine is extended, side bending one direction will cause a rotation to the opposite side (Type 1). These movements are hardly noticeable  but necessary for proper mechanics. In running type 2 motion occurs. When you are landing on your left leg, gravity pushes down on the right shoulder. This will cause your head to be tilted. To get your head pointed straight, your body will have a slight lean to the left.  Side note-When the glutes are weak causing an extreme pelvic drop, the spine has to excessively lean to compensate which leads to injury.

When gravity pushes on the R shoulder
L: Shows the spine without a lean
R: Shows the spine with a lean 


At the same time, the right arm  swings forward to generate a left rotation. The left lean of the spine  and the right arm drive to the left causes a type 2 motion of the spine. Where you place your legs is also important. Mobilizations in a staggered stance verses a squat stance most replicates how the body is moving while running. When the right leg is forward, the right arm swings backwards while the left arm swings forward. The arms are used to drive rotation in the thoracic spine.

Mobilization

One of the exercises to loosen up the thoracic spine is to foam roll. However, this only mobilizes the joint in one dimension. Imagine a drawer which is stuck. Do you keep pulling it straight out or do you wiggle it all directions until the drawer opens. I don't know about you but the later has worked for me.
At 3DRunner we're going to mobilize the thoracic spine functionally in all 3 planes of motion.



Since the arm swing generates a rotation in the spine I decided to check rotational range of motion.
As you can see with my left hip forward, I have slightly less rotation. After the mobilizations, my spine has increase mobility.

Type 2 motion Stand with the right leg forward and left arm next to your ear. Use your right arm to swing backwards. The backwards arm swing will gently mobilize your spine. Try swinging at different angles. Keep the same posture, right arm slightly behind, reach left arm upward towards the ceiling.
Type 1 motion Stand with the left leg forward and left arm next to your ear. Use your right arm to reach forward. With this mobilization, it is more effective to reach as oppose to swing. Reach at different angles. Keep the same posture, right arm forward, reach left arm upwards towards the ceiling

Perform 10-20 of each then switch sides ( right leg forward, right arm next to ear and left leg forward. right arm next to ear)

Mobilizations for the thoracic spine will improve your posture resulting in better core recruitment and breathing to enhance running performance. Improve mobility will promote proper running mechanics to decrease injuries.


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Saturday, August 26, 2017

Improving Hip Mobility using Strength

Stretching is overrated! There I said it!
Stretching helps to improve muscle length but most runners are looking to loosen up muscles by helping muscle fibers glide better. This is accomplished through rolling. If you are generally a stiff person by all means, stretch. BUT, if you're an athlete or a runner who had a muscle or a joint suddenly tighten up on you, you can probably benefit from strengthening. Strengthening will provide stability to the region which allow the muscles and connective tissue to relax.

In the past several days I noticed my right hip is acting up again only when I carry JuJu (14lbs) in her Ergobaby. Mostly, my hip feels sore and stiff. I figure once I return to a consistent core workout routine the hip tightness will go away. Side note- I have a tendency to skip my core exercises as my run milage goes up. The next day while I was rocking JuJu to sleep, I notice my right hip wasn't moving. My right hip felt stuck when I moved side to side with my feet turned out.



Why it's important for running?

When the leg lands on the ground a load is place upon it. Your body weight shifts slightly over that leg and rotates over it. The rotation in the hip is internal rotation. Ok, so why is external rotation important? External rotation is needed to internally rotate. Put your hand on a table and lift one finger up and let it hit the table. Now, use the other hand to lift one finger and let it hit the table. Notice the difference in power. The opposite motion in needed to generate power in the direction you want.




Stability is a key factor in how loose or tight a joint or muscle is. Strong muscles provide stability to joints and surrounding tissue. Weak or inhibited muscles do not provide enough stability to the region and the body will reflexively tighten to provide stability.

In my case, external rotation was limited which  most people would stretch. Since I want to strengthen my muscles I decided perform strengthening in the opposite direction of the limitation, internal rotation. The improve mobility may be an affect of autogenic inhibition. Autogenic inhibition is when the sensors in a muscle are activated during a high stress load to shut down the muscle. It is  a protective mechanism to avoid tearing a muscle. In my case, activating the muscle will trigger it's relaxation. Strengthening in the opposite direction helps re-train proprioceptors of the muscles to work in a greater range of motion allowing for improve stability.

Exercises

Here are a few exercises I performed accentuating internal rotation of the hip. The end of the video shows my hip mobility post exercises. The above video ( purple tank) was filmed earlier in the day. There is a big change in right hip range of motion.



Forward lunges with rotation - Lunge forward and use your arms to rotate the body towards the front leg. This places the front hip in internal rotation.

Side lunges with internal rotation - Perform a lateral lunge with foot pointed in. This will also create an internal rotation at the hip. For greater internal rotation, reach your arms toward the leg.

Cross body lunge - As you lunge forward turn your hips inward. This will create an internal rotate of both hips. This is the best exercise for runners as it most replicates what the hips do in running.

Perform 2-3 sets of 8-10 reps

So when you feel like your muscles are tight and stretching isn't helping, try performing strengthening exercises. Stretching is a short term solution to a long term problem. Strengthening is a key component to keep muscles relaxed.

Tuesday, August 22, 2017

Transverse Abdominals- The Real Core

Returning to running after pregnancy has been an amazing journey. Due to a previous back injury, which was just resolved in 2016, I was nervous and anxious about returning to running postpartum. To my delight, re-gaining my fitness has been relatively straight forward ( as much as it can be with a newborn). A large part of my success has to do with making sure I did my core stability exercise. No, I'm not talking about planks, crunches, Russian twists, etc. I'm talking about real core stability, the transverse abdominals (TrA). I know, I always mention the TrA but these muscles literally held me together. 

Core stability is important to provide a stable center for the legs to move. There are a lot of core exercises, however the muscles which provide stability can be easily compensated for by other stronger abdominal muscles. The muscles which help provide core stability is the transverse abdominal muscles. They are the deepest layer of the abdominal muscles. When these muscles are engaged it provides a stable core allowing proper mechanics of the legs. People have a tendency to contract all of their abdominals too hard, over shooting the TrA. Contraction of the TrA requires a gentle squeezing of the musculature of the lower abs. Also, we think of abs as one unit, these muscles function separately left and right. So one side can be weaker then the other side. 


One of my 1st runs with the stroller... Want a workout?!


I incorporated these exercises while pregnant to maintain my core strength and minimize diastasis rectus. I was able to resumed these exercises within 3 days post partum (consult with your physician post c-section). I was able to return to running 1 month post partum. The best news of all, I didn't have the dreaded diastasis rectus. 


Here are the basic exercise to engage the transverse abdominals. I know where are the 3D exercises? There is a time for 3D functional exercises. To activate the TrA will allow the 3D exercises to work better. 
Feel the TrA on the inside of the pelvic bone


To best place to feel the transverse abdominals contraction is right to the inside of the pelvic bones at the bony marker called anterior superior iliac spine (ASIS). To contract the TrA imagine those bones coming together. Another cue is to pretend to put on a pair of pants that are just slightly too small. 



Exercises






Marches - Lay on your back with knees bent. Tighten your TrA.  Lift one leg up while keeping your abs contracted. Return to resting position and switch sides. Key is to not let pelvis down towards ground. 3 sets of 10.

Fall outs - Lay on your back with knees bent. Tighten your TrA. Let one knee fall to the side, then return to neutral. Alternate legs. perform 3 sets of 10. 


Bridges - Lay on your back with knees bent. Tighten your lower abs. Weight shifted towards the forefoot ( heels remain on the ground) Lift pelvis off the ground. Hold 10 seconds perform 10- 15 times.


Heel slides - Lay on your back with knees bent. Tighten your lower abs. Slide one leg straight and return to neutral. Alternate legs. 1-2 sets of 15. Start with sliding your heel on the ground then progress to keeping the leg up. 

Performing exercises with intent and control will lay the foundation for proper mechanics while running. Good activation of theTrA muscles will minimize injury for not only your back but also your legs.
Let's get the transverse abdominals activated!


Wednesday, July 26, 2017

Return to Running After Injury and Pregnancy


In 2016, I went from running 1 mile with pain to running 13 miles without pain.

The past 2 years have taught me a lot about running, injuries, and recovery. Like many of my fellow runners I was plagued with a chronic injury preventing me from peak training and performance. My most recent injury was traumatic, and it took me 6 years to recover. Years of seeing physicians, getting injections, exercises didn't help.

A little background... In August 2009, I slipped and fell on my back. Like most runners, I continued to run despite having pain in my right side sacrum (tailbone). I remember running on the Great Highway and thinking "ouch", some times out loud, each time I stepped on a patch of sand that had washed onto the path. I decided to change my form so my sacrum wouldn't hurt so much, and it worked for a very short period of time. About 2 months of pain free running into my training I suddenly started having what I call "dead quad' syndrome. My right side quadriceps felt like a brick. From there I had countless MRIs, x-rays, injections, chiropractic work, physical therapy unfortunately none of it helped. Flash forward to 2015. I started seeing an osteopath for prolotherapy with mixed results. One day he decided to check my glute strength in a way I never have seen. While on my stomach, with a towel roll under my ankle, I had to straighten my knee using my glute, and I couldn't do it on my right side. I had been performing clams, leg lifts, bridges...the typical glute strengthening exercises. It was at that point I realized I wasn't weak; I had trained my body to not use my glute muscles.

Once injured, we all want to resume our normal running routine as quickly as possible. Then we end up with injury after injury. I was one of those runners who felt fully recovered from my injury and returned to my "normal" running routine. However, my injury would just return in a matter of weeks sometimes only days. This was not good for the body (or the wallet with countless race entries that went unused). An injury, chronic or acute, changes our movement pattern, which in turn stresses our muscles differently. This quickly leads to imbalances and overuse injuries. Starting slow and focusing on form will help the body relearn the appropriate movement patterns, thus reducing the chance of re-injury.


In 2016, I decided to start at square one.  This was a huge investment of time into my physical and mental health. At the beginning I always wanted to run more than the 1 or 2 miles I limited myself to. However, by the end of my program, I felt the best I ever had. The discipline was worth it! I even ran several cross country races, continued running during my pregnancy, and was able to quickly return to running post-partum.
                                   
Cross country race in San Francisco

My Plan

January:
- Run 2 miles 6 days a week.
- Pick a pace 1 minute slower than comfort level for a 5 mile run.
- Focus on FORM.
- 1st week, no faster then 9 minute mile pain.
- 2nd week, no faster then 8:40
- 3rd week, no faster then 8:20.
- 4th week, I was able to run at 8 min mile pace.

February:
- Up mileage to 3 miles 6 days per week but slow pace down to 9 min miles
- Followed the progression above with adjusted times

April:
- I was able to transition to a more traditional running program.
- One long run, 3 easy runs and 2 challenging runs ranging from 4-6 miles.
- I increased my long run by 1 mile every week ( with a month vacation in June) so by September I was running 13 miles.

During this time frame I felt the best that I ever have! Even running in college I had a lot of aches and pains running that distance.
The fitness gained from the first 9 months of 2016 set me up to be able to run 8 of the 9 months of my pregnancy.
Running at 8 month. I could not avoid heel striking!

Post Partum 

Month 1- I'm not going to lie. When I started walking 3 days post-partum, it was HARD. My neighborhood has slight inclines ( ~2-3%) and my legs were tired walking "uphill" and shaking when going "downhill". I kept my plan. Walk for the 1st month. There was no minimum. Just get out and walk what I felt like.

Month 2- I was released to run at 4 weeks post-partum. My goal was to run every day of June. I start running 1 mile for 10 days, then 2 miles for 10 days finally 3 miles. Then I transitioned to a traditional training program. My goal was to run in a race by the end of July ( 7 weeks of training). That first mile was a challenge. I was sore. But my focus was on my FORM. After about 4 days, my soreness went away and the runs felt good.
Then came 2 miles. I thought it was going to be painful but to my surprise my 2 mile pace was faster then my 1 mile pace. Running 2 miles felt great. I felt my body get stronger and there was better control of my body. I was even able to join my team mate part of her easy runs.
Last, I had 3 mile runs planned for the final 10 days June. There were certain days that I had to slow down to focus more on form. It was most likely the days which the baby was up during the night crying. I adjusted my workout to make sure I was able to maintain my form at the pace I was running.

Month 3 - Over the next 20 days or so I ran 3-5 miles a day making sure I didn't increase my mileage too rapidly.
The week before the race I was able to comfortably run 5 miles in 8:30 pace. So I set a goal of running the 6 mile course in under 50 minutes.

Race Day

It was a long night with the baby the night before the race. My plan was to start slow so I can focus on my form and allow my muscles warm up. I gradually picked up the pace.  With the help of a couple of ladies who I coached while they were in college I was able to push my last 2.5 miles. A couple days shy of 12 weeks post partum, I finished 6 miles in 48 minutes! My time was 2 minutes faster then my goal time. I also negative split the race ( 8:10, 8:07, 7:59, 7:55, 7:47, 7:28). My body wasn't sore. But, it's better to test my body then to go all out with the possibility of being so sore I couldn't run for a few days.


Post race sweaty cuddles


What I learned was a slow return to running with a focus on form was the best way to recover from an injury. All the times of jumping back into a running" once I felt better" made it so my recovery was longer. It took months of slow, controlled running to get back on track. I wish I knew this years ago!
Please let me know your thoughts on recovering from an injury and return to running.

Stay tuned. Next blog post is on the core exercises.


Tuesday, June 13, 2017

My Running Analysis


I'm back! Some of you who have been reading my blog may have noticed I took a hiatus. Well, I now have a little to take care of. She is 6 weeks old today. 
I was feeling feeling miserable towards the end of the 1st trimester but able to resume running in the beginning of the 2nd trimester. I ran until I was 7 months pregnant. Then I decided it was time for my body to transition to walking. I resumed running at 4 weeks postpartum . For the most part, I feel pretty good. However, there is a bit of nagging foot pain on my right side. I decided to do my own running analysis. 

Analysis 









Like I suspected, the angle that my right foot contacts the ground is much steeper, 20 degrees vs 12 degrees, then my left (Bottom photos). The steep angle suggests a decrease in surface area that my foot has to dissipates force when it hits the ground. This causes increase stress to the structures on the outside of my foot. If left unattended, it can eventually lead to inner foot pain due to the larger distance my big toe has to reach the ground. 

Why is My Foot Doing That?

During swing phase my right foot turns out more that my left (top photos, a little confusing but the "right" and "left" is for stance leg). This is a sign that I circumduct or "circle" my foot as I swing my foot from back to front. The foot naturally turns up to make sure the big toe clears the ground when the foot makes contact. 
Circumduction occurs due to an improper push off from the ground. This is a result of ... WEAK GLUTES. When the glutes are strong the muscles function to control extension of the femur as the leg pushes back. However, when the muscles are weak, the femurs not properly controlled by the glutes. Due to gravity and weight of the leg, the foot turned outward.

Treatment


The best way improve form is to focus on proper muscle recruitment. I don't see this as changing my form. I see as training my body to use the appropriate use muscles. 

Stand tall and lean forward from the pelvis from both sides. You would be surprised at how different each side can be. Then "cycle" the knees. I use the cue "push the knee back" as it contacts the ground. Don't worry, your knee will never fully straighten. Using the "push the knee back" cue will force the femur to extend straight back. Having the appropriate posture will allow your body to be in proper alignment to use the gluteal muscles. If you were to stand up without a forward lean, you will most likely feel your quadriceps when you "push the knees back" cue. 




In latter part of the video, you can see in the "normal form" my body is behind my pelvis and I land with a heel contact. This leads to instability of my core and lack of control of my lower extremities. In the "cycling knees", my body is over my pelvis and I land with a mid foot contact. There is improve core stability and control of my legs ( and no pain in my foot) Now, I have to be able to maintain muscle recruitment through my run. Research shows initially the muscles will be activated for 20-30 seconds before fatigue onset (muscle and nervous system). I remind myself every few minutes to stand up straight, push my pelvis forward and cycle my knees.


The above pictures shows a change in angle after cycling the knees using the "push the knees back" cue. The angle of the right foot during swing went from 17 degrees to 10 degrees ( and left leg 8 degrees). The angle of the foot during initial contact with the ground went from 20 degrees to 8 degrees (left leg 12 degrees). There is a 2 degree range
in the different positions that I measured.

Please let me know what you think. 

With these techniques, during 2016 I went from running a mile with pain to being able to run 13 miles without pain in 6 months.

Here's baby JuJu ( 5 weeks 6 days) and I post videoing


Saturday, January 7, 2017

Properly Performing Squats to Recruit Glutes

Gluteal activation seems to still be a mystery. There are new terms like “Dormant butt” syndrome or “Dead butt” syndrome, but the problem is still the same. Our butts aren't working! We perform strengthening exercises but the strength doesn’t translate to running. 

Over the past year, I have been researching the best way to get the glutes recruited while exercising and running (also cycling). 

The first thing I look at in my patients is “Can they isolate their glutes independently?”. This is important because when the foot makes contact with the ground, the glute contracts. Meanwhile, the other glute relaxes to allow the swing leg to move through the air. If the gluteals do not function independently, our body will allow the leg to swing and the stance gluteal will not contract. This is the basis of why we don’t recover from a gluteal strength based injury.

My first exercise seems easy, but requires a lot of focus. It lets me know if my client is able to independently contract the glute and if there is a difference in contraction between the sides. This exercise is a prone single leg glute set.





 




Lay on your stomach with a foam roller under the ankle. On one side straighten the knee then contract the glute muscle ONLY on that side. Hold it for 10 seconds. Now try the other side. Is there one side that is harder then the other? There usually is! Perform this exercise 10 times each ( no matter which side is weaker) 10 seconds 2-3 times a day. If you don’t have a foam roller, a rolled towel can be used. To make this more challenging put 2-5 lbs ankle weights behind the knee or use a theraband and use the opposite knee to anchor the band.

My next exercise is bridges. People commonly dig their heels into the ground when they lift up to bridge. This engages the hamstrings. Usually my older patients get hamstring cramps when bridging up. To focus on the glutes, shift the weight into the forefoot as you lift your pelvis up.  Perform this exercise with a 10 second hold 10 times. To advance rest ankle weights (or text books) across the abs. To further advance, perform a single leg bridge.

What about the squat? The squat is a basic exercise to strengthen the legs and glutes. We SHOULD feel the exercise in our glutes since they are typically weaker then the quadriceps. However, when I ask my clients which muscles do they feel when squatting, they say quadriceps.  I often have to cue my patients to squeeze their glutes. The quadricep are much stronger then the gluteals, so why is the work felt in the quads? I would like to argue it's mechanics and body positioning. 

The ready position in most sports, such as football, volleyball, tennis, involve being a squat position with weight shifted onto the forefoot. The legs can spring off the forefoot and push forward. With the foot fixed on the ground on the body in a forward lean position, the gluteals are forced contract to extend the leg.

My believe is squat form changed to compensate for preventing our knees from going over our toes. The easy fix is simply instructing people to sit back in the heels. This simple cue to save our knees in the short-term, may have doomed our butts. By shifting our weight into the heels we end up engaging the thighs, the quads and hamstrings. I started performing squats with my weight shifted into my forefoot while keeping my knees behind my toes. As I stand, my focus is to straighten the knee. Voila! I feel my glutes engage NOT my quadriceps.




For the past several months, I have been re-cuing my clients and patients to squat and lunge with their weight shifted forward and straightening their knee to stand up. They have been able to recover from their injuries faster. 

By using the cues to shift weight into the forefoot and focus on knee straightening to stand up, the gluteals will be better isolated. To add a variation I use these cues for a lunge matrix and single leg squat as well as jumping drills. By keeping these cues in mind, you'll be able to recruit the glutes and keep running!

Side note: If shifting weight towards the forefoot to recruit the glutes work, does this make an argument for forefoot (or mid foot) running?

Thursday, November 24, 2016

Mizuno Wave Rider 20 Review





The Mizuno Wave Rider was my training shoe of choice for years while racing in college and post collegiately.  When I heard the Wave Riders were getting a complete makeover, I was so excited to check them out. As a Fitfluential ambassador, I got the opportunity to review the new Wave Rider 20. 




Running shoe companies like Mizuno have continuously evolved their running shoes as new technology is developed, and this newest iteration of the Wave Rider is no different. The Wave Rider  showcases their new Cloudwave Geometry,  a new midsole and updated mesh.




Although the Wave Rider is categorized as a "neutral" or "cushioning" shoe, the Rider provides a level of ground response that makes these shoes feel more alive when running, and enough support which kept my foot on an even keel after stepping on a rut on the road or a rock on the trail. This does not mean that the shoe lacks cushioning; The legs rolled on and the miles kept accumulating without excessive fatigue associated with shoes that have gone thin. It is not a stretch to say the feel of this shoe is attributed to the new Cloudwave Geometry, it certainly did not make it worse. 

The fit is amazing! Through long runs the Wave Rider feels snug without rubbing my feet. The tongue stays up providing a nice padding for the front of the ankle through rolling hills. 

The only real critique is that while the shoe is responsive, the Rider has a heel bias typical with shoes of this type. During fast interval runs or runs trying to maintain mid-foot strike, this shoe can feel cumbersome, even tiring.





Overall, they provide great support and cushioning for most of my running up to fast tempo runs. 


Note: I received these shoes for a review at a small fee.
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