Are you READY TO RUN?

Ready to Run was released in October 2014, and is designed to help runners recover from injury. This book is written by the same author who wrote "How to Become a Supple Leopard," physical therapist and co-founder of San Francisco Crossfit, Kelly Starrett.

"Ready to Run in organized into 3 main sections: the introduction, the 12 standards, and mobilizations. 

Below are the 12 standards which are assessed in order to be "Ready to Run".

1) Neutral Feet

2) Flat Shoes

3) A Supple Spine

4) An Efficient Squatting Technique

5) Hip Flexion

6) Hip Extension

7) Ankle Range of Motion
8) Warming up and Cooling Down

9) Compression

10) No Hotspots

11) Hydration

12) Jumping and Landing

Starrett goes thoroughly details each of the standards by explaining what it means, why it is important and how to fix it. Each standard has a "Runner to Runner" section which is a story related to the topic written by co-author T.J. Murphy. If appropriate, he recommends mobilizations for each of the standards. The mobilizations are strategies on how to improve mobility of the region, and are detailed at the end of the book.

So does Ready to Run really get you running ready?

I allotted myself 3 weeks to work the recommended mobilizations to help achieve Starrett's 12 standards. Below is a sampling of my results. The pictures on the left were taken at the beginning of the 3 weeks, while the pictures on the right were taken after the mobilizations were performed.

Posture - Front view

Posture- Side view

After performing thoracic mobilizations and pectorals soft tissue work, my posture has significantly improved. My back is straighter, my neck is over my body and my shoulders are pulled back. This helps to reduce the stress on the low back, neck and shoulder.

Hip Flexion

I am able to lift my leg higher and with less struggle. In the pre picture my trunk is rounded forward while in the post picture I maintained an upright position. 

Hip Extension

There is more hip extension in the post picture. Hip extension allows better recruitment of the gluteals and decreases stress to the lumbar spine.

Squat Position - Front view

Squat Position - Side view

There is significant change in the pre and post squat position. I am able to get lower and keep my back straighter in the post pictures. In the side view of the pre picture, you can see the stress in my neck from the crinkling in my skin. Also, in the pre picture you can also see the change in the curvature of my lower back.

In addition, I also worked on the other standards by wearing my compression socks, using the compression band ( please see http://3drunner.blogspot.com/2014/08/compression-band-for-lower-extremity.html) and staying hydrated.

Pros

Ready to Run is a great tool not only for runners, but for just about anyone who is looking to improve their mobility. The book is chalked full of information on injuries, mobility and self mobilization techniques.

Born to Run also does a good job instructing readers on how to perform basic mobilization techniques, and helps you take charge of improving your mobility.

Finally, Starrett also does a good job covering other contributing factors such as shoes, compression garments and hydration.

Cons

Ready to Run presents a lot of techniques, and due to the organization of the book it can be difficult to deduce what injuries are related to what specific limitations. As a result, you may end up performing all the mobilizations in the book (which is not necessarily a bad thing, it just takes awhile).

While the mobilization techniques are nicely organized with their own appropriately titled chapter in the back of the book, compression techniques are found within the standards section titled "No Hotspots." This can make the compression techniques a little difficult to find, especially if reading the text as reference material.

Decision

I think Ready to Run is a great tool for beginners and veterans alike. If you would like to learn self treatment techniques in order to minimize and prevent injury then check out Ready to Run.

I Have Sciatica, Why Are You Grabbing My Foot?

It is 5 am in Badwater, CA. There are approximately 100 runners toeing the chalked line. There is 135 miles, over 10,000 ft in elevation gain and 120 degree heat under the Death Valley sun between them and the finish line. I see my runner crossing the horizon towards our support car, his stride looks shortened, but smooth for mile 60. Over the next 75 miles we take turns passing off race essentials. At 4 am, as a team, we cross the finish line at Whitney Portal.

So how did this journey begin?

From the moment I met him I could hear the “thud”. It was the sound that his foot made as it he walked through the clinic.  He tells me he is a runner, but not just a runner, but he is running in the Badwater Ultramarathon in July. 135 miles of “thudding” into the ground! To bring the pressure up a notch, this is going to be his 11th consecutive finish. As I watched him move and walk, I can't stop focusing on the stiffness of his foot which is causing the "thud". But how do I explain his lack of foot mobility is contributing to what he is actually coming to see me for… SCIATICA?

What is Sciatica?

Sciatica is a general term used to describe inflammation of the sciatic nerve or nerve roots which comprise it. Sciatica can be caused by a disc injury or stenosis (narrowing of spaces of the spine), which puts pressure on the nerve roots. When our foot hits the ground force is transferred up the leg and into our lower back. Our foot is designed to pronate upon impact to allow for shock absorption.  The bony anatomy of our foot and ankle causes a biomechanical chain reaction. This generates a rotation in the leg then into the pelvis which helps to recruit the gluteals to provide the stability of the back. However, if the foot remains supinated, ground reaction force is transferred into the spine instead of being absorbed through the foot and leg. When the mobility of the foot is limited, the lower back is forced to move more to compensate for the lack of motion. The increase motion of the back decreases the amount of space the nerve has to pass through the spine.

When the foot pronates it causes a rotation up the leg which
helps to dissipate force and maintain good motion of the back.

When the foot remains supinated the foot remains rigid forcing
the back to rotate more which decreases space for the nerves.

To improve his foot mobility I begin to facilitate pronation of his foot. IT worked! His sciatic pain decreased.  I worked on it some more and his pain was gone! He was able to walk and jog in the clinic without his symptoms. 

From the moment I helped his foot become more supple and pronate, his sciatic pain got better.

So when you foot hits the ground: is it supple (pronated) or rigid (supinated)?

             

You can even see from the pictures above the difference in the position of the pelvis.

Techniques

Mobility

The technique is performed to increase mobility of the foot to reduce stress to the lumbar spine. This will help minimize your risk of sciatica. Stenosis is narrowing of the canal in which the nerves exit the spine. If you have a herniated disc, this is NOT a technique for you.

For forefoot runners, it is also important to have a mobile foot. The motion of supination and pronation occurs in the forefoot instead of the mid and rear foot.

Strengthening
After mobilizing the foot, it is important to retrain the muscles and joints in this new motion. This allows the newly acquired motion to be recognized as a movement path. If your body doesn't use this motion, the foot and ankle will become stiff again.

Here are examples of exercises which use the muscles and joints in all 3 planes of motion to retrain the body.

Please consult with a health care professional prior to performing these exercises. If it increases your pain, STOP!

Compression Band for Plantar Fasciitis, Ankle Sprains and Knee Pain

At the request from multiple people, this post is focused on how to use a compression band (voodoo band) for the lower extremity. The feedback I receive after being wrapped is the treatment area feels lighter, more mobile and less achy. This is does not fix an injury but a way to manage your symptoms.

On the left is a home-made compression band from a bike tube.
On the right, is the compression band aka. voodoo band

How the compression band works

The band works by providing a compression onto the connective tissue. Imagine our connective tissue as a kitchen sponge. When it is being used, the sponge soaks up dirt and grime. When the sponge is compressed the dirty fluid is squeezed out and upon release fresh water is absorbed. By pushing stagnant fluid out and allowing fresh fluid to enter, our soft tissue is lubricated and mobility is restored! Drink Water!

How to use the compression band

Stretch the band about 50-75% and cover half of the prior band. I recommend performing stepping motions in all 3 planes of motion to maximally compress the different aspects of the connective tissue. The band stays on for no more then 2 minutes maximum!


DO NOT use the band if you have peripheral vascular disease, peripheral neuropathy or being treated for cancer. Take the compression band off if the tissue becomes gray, have numbness and tingling or have sudden claustrophobia

The band can be purchased online or you can cut a bike tube in half and split down the middle for a flat band. Note: A bike tube is much shorter then the 7-foot band and you'll smell like rubber.

I will demonstrate on to use the band for the lower extremity - foot, ankle and knee. 
The band can help reduce symptoms associated with plantar fascia, ankle sprains, Achilles tendonitis and general knee pain. 

Plantar Fasciitis 

Start the wrap at the base of your toes and wrap around the foot and onto the ankle. Tuck the end in. You can perform toe curls and extensions, ankle pumps and ankle circles. For the best effect perform a lunge matrix. 

Ankle Sprains and Pain

For ankle sprains, start the band the base of the ankle. Always start the band distal to the ankle to push the swelling into the leg to be absorbed. You want to cover the skin as much as you can so the swelling doesn't get pushed into the uncompressed area. Covering the entire surface around the ankle can be tricky. I recommend completely covering the heel with one circle and angling the ankle down.

This method can also be used for Achilles tendonitis.

Knee pain 

Start the band below the kneecap. You should have enough the cover the entire knee. Tuck the end of the band under the. You can bend and straighten your knee at different angles or contract your quadriceps muscles. My recommendation...  a lunge matrix!

The band can also be used around your muscles such as quadriceps and calf. 

Please see your MD if your pain is a chronic or serious injury.

Those who have use this please comment and give your feedback!

#compressionband #voodooband #kneepain #anklesprain #achillestendonitis #plantarfasciitis # pain 

So Why Can’t We Recruit our Glutes?

Recently, I have noticed an increase in discussion on how weak gluteals are linked to numerous injuries. Injuries such as hamstring strain, knee pain, and low back pain can all be traced back to weak gluteals. We diligently stretch and strengthen but we all still seem to have difficulty activating our gluteals…WHY? Well here are some reasons:

We sit a lot!

Nearly all of our daily activities are performed in seated position. From eating a meal, driving, sitting at a desk at work, to relaxing on the couch; the majority of day is spent sitting. Additionally, we don’t always sit up straight. We lean against the couch end, we scrunch up in an airplane seat, or we squint at our computer screen, all of which leads to imbalances in our body. From prolonged sitting, the soft tissue in our glutes becomes desiccated and stagnant making it difficult to recruit and generate force. Furthermore, the tightness in our hip flexors also contributes to greater difficulty recruiting our glutes.

In a typical workday, an office worker can sit upwards of 14 hours! Does 10, 20, or even 30 minutes of stretching and strengthening our hips and glutes make a difference? It depends! If a person’s goal is to walk without pain, 20 minutes of exercise may help. BUT if a person’s goal is to return to running a marathon, 30 minutes worth of stretching and strengthening will likely not cut it.

Here’s a video on how to lacrosse roll glutes – One way to restore the soft tissue is to roll it out. By applying pressure on the muscle it pushes the stagnant fluid out and upon release new fluid is allowed in. The process is similar to how a kitchen sponge works.  

Bonus Videos on hamstring!

Is All Pelvic Drop Really Bad?

When standing on one leg study your hip alignment in a mirror. When you lift one leg the pelvis drops on the opposite side, it is an indicator of a weak gluteal in the standing leg. This is called a pelvic drop. There is discussion that the pelvis must stay level in order to obtain proper running form because it’s a sign of a strong glute. Current consensus states that allowing the pelvis to drop can lead to bursitis, ITB syndrome, and knee pain. However, in order to properly load the glutes, the femur must be able flex, adduct and internally rotate relative to the pelvis. Allowing the pelvis to drop (hip to adduct) will actually recruit the glutes. The glutes’ ability to decelerate tri-plane motion is what actually helps keep us injury-free.

Recent biomechanical research agrees that some amount of hip drop is acceptable. If one of those movements is lacking it can place extra stress onto other motions.

The pictures on the left (top to bottom) show the difference in pelvic drop on the right leg (4 degrees) compared to left leg (8 degrees), prior to tri-planar stretching and still with symptoms. The pictures on the right show demonstrate an equal pelvic drop achieved from tri-planar stretching. This results in the ability to run with minimal to no pain.

My example- I had a slip and fall injury which took over 4 years to recover from. I saw numerous MDs, had countless MRIs (often hoping for a positive result, but always coming back negative) and several injections without any relief. It was noted by fellow professionals that I had opposite hip pelvic drop, so I took up a regimen of traditional hip exercises (clams, bridges, etc.) with minimal change. I decided to look at my own videos and concluded that my injured hip did not have ENOUGH pelvic drop. Since I started working on hip mobility I have been able to return to running with minimal symptoms.

So listen to your patient or client and screen the whole body in a kinetic chain and in all planes of motion.

Do Clam Shells Really Get You Back To Running

      Maybe? Traditional gluteal strengthening exercises such as clams, hip bridges, leg lifts and planks provide a good foundation. However, in order to function you must perform exercises that replicate the motion you are trying to fix. The traditional exercises are not authentic to the movement of running. Performing functional exercises in an upright position are necessary to return to functional strength.  While basic strength exercises are necessary for a strong foundation, functional exercises are equally, if not more, important because it resembles our activity, RUNNING. After a long day of sitting, performing activation exercises prior to your run helps to stimulate the muscles. Running requires impact, impact which can injure if our muscles aren’t ready to take it. Think of activation exercises as something to get the rust knocked off of your shock absorbers to prepare the muscles functionally for the impact of running. To help recruit your gluteals while running, when your foot hit the ground kick the leg back and slightly outwards. Perform this activation exercise during the first couple minutes of running to stimulate the glutes.                          

Clam exercise - does it resemble running?

Lunge with reach - resembles running!

Please refer to the post on strength for functional exercises.

PLAN

 1)   Lacrosse ball roll glutes or any other body part. My pre-workout routine is roll out hip flexors, upper back and glutes. I also roll my calfs and quadriceps if they feel tight.

 2)  Make sure your motion in all three planes is adequate on both sides. Stretching my left hip allows my RIGHT hip to go into the frontal plane!

 3)  Perform not only basic glute exercises but functional exercises to gain a good foundation and tri-plane strength. Do activation exercises prior to your run!

3D Stretches for Runners

As runners, we have all been exposed to stretches but recently there has been so much controversy. Is it good or bad? Before or After a run? Dynamic vs Static?
Here's my take!

Is stretching good or bad? I will have to argue stretching is good. Stretching reminds our body of the range of motion which is available to us. Sitting through the day promotes tightness in a position which is completely opposite of running.  Stretching restores mobility which increases power. Visualize an old rubber band and the power it generates versus a new, mobile rubber band and the power it generates. The mobile rubber band has more elastic recoil which generates more power. Running efficiently relies the ability to stretch and rebound.

Before or After? It depends on the purpose of the stretch. Performing stretches before a run can give the body the mobility to move with proper mechanics. After stretches I perform a series of light strengthening exercises to load the muscle in the new range of motion.* During a workout muscles tighten due to the chemical waste products produced and micro tears of the muscles during the run. Performing stretches after the run can help increase recovery by facilitating mobility.

Dynamic vs Static? Dynamic! Our body is 3 dimensional, by performing only static stretches  encompasses part of the muscle. By performing motions in all 3 planes of motion more muscle fibers are included in the stretching. There is a time and place for static stretching but for athletes, dynamic stretches help to muscles warm up. Dynamic stretches is controlled movements not ballistic bouncing. 

*Please see my post on strength exercises. Prior to a run, I don't use weight.

I perform these stretches prior to my run about 30 seconds and up to 2 minutes depending where my limitations are that particular day.

1) CALF STRETCH

I used a piece of wood under my toes to increase the ankle angle allowing a deeper stretch. Use your pelvis to drive forward, side to side and twist while keeping the heel on the ground. To focus on the soleus muscle, bend both knees.

2) HAMSTRING STRETCH

Place one leg on a bench with the knee slightly bent. Since the knee is never fully straight in the swing phase of running, I keep it in a relax position and drive my body over my hamstring. Use your hands to drive the body forward, side to side and twist.

3) QUADRICEPS STRETCH

Place your foot on the bench with the knee bent behind you. Tuck your pelvis under your body until a stretch is felt in the front of the thigh. Use your hips to drive forward, side to side and twist.

4) HIP FLEXOR STRETCH 

Place you foot on top of a bench. Tuck your pelvis under your body. Use your arms to drive forward and backwards, side to side and twist. This may be one of the most important stretches to perform if you work at a desk. Hip flexors shorten from prolong sitting but for a good stride it needs to be flexible.

5) GLUTEAL STRETCH

Place one leg on a table  at about mid thigh to hip height depending on flexibility. The knee should be bent to 90 degrees and thigh perpendicular to body (very important!). From there, hinge forward in the sagittal plane, reach away sideways in the frontal plane and rotate towards in the transverse plane to the stretch leg. These motions create length at the hip and pelvic junction. 

6) THORACIC SPINE MOBILIZATION

Rotation T/S stretches- These stretches improve the rotation of the spine.

To improve rotation of the thoracic spine while the arm is swinging forward - Take a step forward with L leg and L arm next to head, bring R arm in front of body and reach forward. 
To improve rotation of the thoracic spine when the arm is swinging backwards - With L leg in front and R arm next to head, swing L arm behind the body.

3D Strength for Runners

As runners we are great at moving our body forward in the sagittal plane over LONG periods of time. On top of that, most of us strengthen by performing squats, lunges, bench press, etc. which promotes mostly the sagittal plane of motion. What we don't realize is how much side bending (frontal plane) and rotation (transverse plane) our body goes through while running.

Here is a series of exercises which focus on the frontal and transverse planes of motion we use while running. These exercises have a foundation based on lunges and squats by using our arms to drive motion in other planes of motion. Using our arms as a driver also strengthens the core and upper extremity.

These exercises can be performed prior to a run ( after stretching) for muscular activation. When performed prior to a run, do not use any weights. For strengthening use between 5 - 10 lbs., depending on the exercise. This helps to build muscles in all three planes of motion.

In addition to tri- plane exercises, I perform more traditional strengthening exercises such as squats ( 135 lbs!!), pull ups, power cleans and dead lifts. However, lack of strength and endurance of muscles which control the accessory motions (frontal and transverse plane) contributes to fatigue leading to injuries. Adding tri plane exercises to your strength routine will help reduce fatigue, and as a result, decrease your susceptibility to injury.


These are basic tri-plane exercises but can be made more complex as the athlete becomes familiar with the techniques.  



I perform 10 repetitions, typically 3 rounds using 5- 10 lbs.

FORWARD LUNGE WITH OVERHEAD REACH

Yes, this exercise is done in the sagittal plane. However, this exercise is powerful because bringing our arms overhead enhances extension of the core muscles. Lifting our arms overhead also creates an eccentric load through our abdominals which is how it contract while running.  

Take a step forward while bringing both arms overhead. This creates extension through the trunk and the hip flexors. To make the exercise more similar the running, bring the same arm overhead as the leg stepping forward ( as shown in the front view). Bringing the same arm overhead will help create a rotational movement in the upper body similar to the arm swinging back.

SIDE LUNGE WITH SIDE REACH

This exercise helps to promote the frontal plane motion which occurs while running. As the leg swings forward our body weight shifts laterally over the front leg. Bringing the arm out to the side drives a rotational motion in the thorax eccentrically loading the abdominals. 

Take a side step while bringing the same side arm to the out and behind. ( similar to a throwing motion). Focus on sitting back through the glutes, having your torso shift over your knee and keeping your foot facing forward.

BACKWARDS CROSSOVER LUNGE AND CROSS REACH

This backwards lunge helps to promote gluteal activation in the frontal plane while using the arm to drive upper torso rotation. 

Reach backwards and across the stance leg while reaching the same side hand in front of the forward leg.

SPLIT SQUAT WITH CROSS BODY ARM SWING

This exercise focuses on rotation of the trunk and loading the hip in a transverse plane of motion. 

Place one leg in front and as you squat down swing the same side arm behind, As you come up swing the arm cross body. Stop the motion with the other hand.

FORWARD LUNGE WITH CROSS BODY REACH

This lunge helps to generate the transverse motion of the core and glutes using the opposite arm as the driver.

As you lunge forward reach opposite arm in front of the knee. As you step back bring arm up and out to the side.

To increase the challenge as you step back, step through so the swing leg is behind the stance leg. 

BALANCE WITH TRI-PLANE ARM REACHES

A running training program is complete without balance exercises. Balance on one leg - reach both arms up forward, up backwards, right side, left side, right rotate and left rotate. This represents the different cardinal planes of motion. To increase the difficulty alternate reaching one arm at a time. I recommend switching the balancing leg each time so your arms aren't fatigued when it's ready to switch sides. 

PLANKS WITH PELVIC DRIVER

Last but not least planks! I don't perform my planks with a hold. I use my pelvis to drive my body in the 3 planes of motion. Use the pelvis to drive up towards the sky, down towards the ground ( drive with your pelvis, don't let your belly sag), side to side and twist to both sides. To change the exercise and challenge your muscles differently, change the foot position or hand position. I put my feet so they are touching. You can put your feet wide, turn your toes in, hands together, the patterns are endless.

As in all exercise programs, if it hurts don't do it! Consult a professional!

ANKLE SPRAIN - How the Thoracic Spine and Hip Can Contribute

Recovering from an ankle sprain appears to be pretty straight forward, however there are other factors which can hinder recovery. The two areas we will focus on are the hip and thoracic spine (upper back). Daily activities in the sitting position, such as computer use, reading and driving, etc., results in an increase stiffness in our hips and thoracic spine.
The tissue surrounding the gluteals become stagnant from prolong sitting making it difficult to generate force and absorb energy. At the same time, the hip flexors in the front of our pelvis shorten from sitting.
The thoracic spine is another region which is affected from prolonged sitting. The muscles of the thoracic spine work to fight gravity which pulls our trunk forward. Most daily activities which are performed in front of our body also contributes to increase pull forward.  To make matters worse, the thoracic spine is a difficult area to stretch due to the bony anatomy and rib cage.
Limited mobility of the hip and thoracic spine changes our biomechanics which can impair the body's ability to recover from a lateral ankle sprain.

HIP

Hip Mobility

When the heel hits the ground, the bony anatomy of the ankle generates a rotational force up the lower leg and into the thigh. At the same time, the body weight shifts from the back leg to the lead leg which produces a lateral motion of the hip and pelvic junction.

If there is a limitation of frontal plane motion of the hip, the movement will find another path. A common pathway is the ankle.  As the body shifts laterally to the front leg with a limited hip motion, the lateral movement will be forced at the ankle causing a lateral ankle sprain.

Hip Mobility Assessment

Stand with your legs hip width apart. Bring your arms up next to your head. Reach to the side as far as you can, then to the other side. Feel for any difference in motion in your hips from side to side. You may need to stand in front of a mirror or have a friend to give you feedback.

The above pictures show less mobility on the left hip (picture on the right). The larger hip/pelvis angle reveals there less motion occurring at that joint. Side note: I roll my left ankle during this run.

Hip mobility Treatment

Lateral hip stretch -

To stretch the side of the hip, stand next to a low bench or step. Place the leg across body onto the step with the knee bent. Allow the body to move over the stance hip until you feel a stretch. Use your pelvis to drive forward, sideways and twist. Please refer to the video above.


***Bonus lateral hip stretch - Instead of crossing the leg in the front, cross my leg behind my body.  Make sure the back leg does not twist the body away from the stance leg. Shift toward the stance leg. Then use the pelvis to drive the body in the sagittal plane, frontal plane and transverse plane. Please refer to the video below.

Gluteal Stretch -

Place one leg on a table ( at home I use the end of my couch, kitchen or bathroom counter) at about mid thigh to hip height depending on flexibility. The knee should be bent to 90 degrees and thigh perpendicular to body. From there, hinge forward in the sagittal plane, reach away sideways in the frontal plane and rotate towards in the transverse plane to the stretch leg. These motions create length at the hip and pelvic junction. Perform about 10 repetitions per plane of motion or until you feel improvement in flexibility.
Refer to the video above for planes of motion.
*** Hinge at the hip NOT the lumbar spine.

THORACIC SPINE

Thoracic Spine Mobility

When one leg is swinging forward, the same side arm is swinging back. The swinging of the arm backwards drives rotation of the upper back. For example, as the right leg swings forward the right arm swings backwards. A rotational motion is created at the core since the opposite leg is behind the body. This position helps to load the abdominals in a rotatory fashion, similar to a spring.
If the thoracic spine is tight, the rotation will bypass the region and the motion in transferred elsewhere. Occasionally, this force causes a shearing motion in the back. Other times, the force goes into the ankle.

Thoracic Spine Assessment

Place one leg in front of the other with the knee slightly bent. Bring your arms in front of your body at chest level. Turn as far as you can towards the front leg then towards the back leg. Switch so the other leg is forward. Feel for the rotation in the thoracic or have a friend watch for you.
Watch the video below.

 

Thoracic spine treatment

Rotation T/S stretches- These stretches improve the rotation of the spine.

To improve rotation of the thoracic spine while the arm is swinging forward - Take a step forward with L leg and L arm next to head, bring R arm in front of body and reach forward. 
To improve rotation of the thoracic spine when the arm is swinging backwards - With L leg in front and R arm next to head, swing L arm behind the body.
Refer to the video below.

To maximize the effects of the stretches, follow up with strengthening exercises. Performing strengthening exercises after stretching will stimulate sensors in the newly acquired range of motion which may have been dormant for weeks, months or years.

Stay tuned for my next post on strengthening exercises for runners!

ANKLE SPRAINS

Throughout my years of working with athletes, I have come to realize that most runners experience a lateral ankle sprain at some point. Unfortunately, when I ask athletes what they have done to rehab, most say "I ice" or even worse,  "nothing". A lateral ankle sprain occurs when the outside portion of the ankle rolls towards the ground.

While performing my assessments, I have found that an untreated or ill treated ankle sprain is the underlying culprit for most other insidious onset of injuries in the lower extremity. It doesn't seem to make a difference if the ankle sprain happened 1 month ago or 10 years ago. They all have lasting impact on the mechanics of the body.
If you have an injury, ask yourself, " have I EVER had an ankle sprain?" "Do I have an injury on the same side as the ankle sprain?"

WHAT HAPPENS?
The moment you feel your ankle roll, an inflammatory response occurs. This inflammatory response induces chemical reactions which allow an increase of fluid into the injured region. Micro tears occur in the muscles and ligaments of the lateral ankle. When proprioceptors are stretched, the body has an increased difficulty communicating the joint position to the brain. This leads to an increased susceptibility to future ankle sprains.

Change in biomechanics

Swelling takes up joint space, making it difficult to move, and limiting range of motion (ROM).  Over time the impaired motion limits joint mobility resulting increased stiffness of the capsule (tissue around joint). The limited ankle dorsiflexion ROM also contributes to instability since the plantar flexed position is unstable due to bony anatomy. Our body, in its attempt to find the path of least resistance, moves through another joint. This leads to injuries in other regions not meant to take the stress.

How do we rehab from an acute ankle sprain?
Immediately after injury, the first priority is to manage swelling. Minimizing swelling will help decrease pain, maintain good ROM and mechanics. Next, recover proprioception through balance exercises to regain sense of joint position. If joint motion is lost, it must be restored as quickly as possible.

EXERCISES

Mobility

There are several ways to improve ROM of the ankle joint. Here's how to use the swing leg to drive an ankle stretch in all 3 planes of motion. The movements help to engage more muscle fibers then the typical forward stance. There are 2 muscles which make up the calf, gastrocnemus and soleus. The gastrocnemus is stretched when the knee is straight and soleus when the knee is bent.

Tri-plane gastrocnemus stretch: swing leg driver (video below) - Stand with one leg forward with the front knee bent. Shift your body forward until you feel a stretch in the calf of the back leg. Use the forward leg the drive in the sagittal plane, frontal plane and transverse plane.
To stretch the soleus, bend back leg and perform the swing leg driver in 3 planes.

*** Most shoes have more cushion at the heel which makes it difficult to stretch your calf. If you don't feel a stretch, go barefoot, or use a towel, tree root or rock under your forefoot to get a better angle.

Balance training

The proprioceptors need to be retrained after being over stretched after an ankle sprain. Single leg balance activities are the best way to improve function.
 Single Leg Balance - Standing on one leg is the best exercise to improve balance. Since vision contributes to balance, closing your eyes will increase the difficulty. Another way to increase the challenge is to look left and right or up and down. Mimic running by standing on one leg while swinging your arms. 

Balance Reaches (video below) - A balance matrix exercise uses your leg to create instability in different planes on the standing leg. You reach forward (sagittal plane), to the side (frontal plane) and rotate to the back (transverse plane). Initially, you can gently tap the ground to provide stability, then progress to reaching without touching the ground. To make this more challenging reach to toward the stance leg. This encourages lateral motion of the ankle which is the position of an ankle sprain. Balance reaches performed in these positions train the ankle to recover prior to reaching the critical point of a sprain.

Variations on SL balance
1) look over your shoulders
2) hand reach side to side or cross body

                                     

Strength

One way to strengthen the muscles around the ankles is to perform a tri-plane heel raise.
Heel raises (3D style) - Most people know how to perform a heel raise. Performing the exercise with different foot positions changes the emphasis of the muscles being used. There are seven basic foot positions: normal, narrow, wide, toe out, toe in, right forward and left forward. The exercise can be changed to fit the needs of each individual. An example is instead of raising straight up, perform a twist in all the foot positions. This promotes the transverse plane.

                                       
*** Perform these exercises to your comfort level and in a pain-free range. These are general exercises demonstrating the use of 3 planes of motion to get your body moving after an ankle sprain. Visit a movement specialist for exercises specific to your biomechanics presentation.


OTHER CULPRITS

When the ankle hits the ground a simultaneous chain of events begins. As the foot strikes the ground a reaction occurs up the lower extremity, while at the same time being driven by top down motion of the arms swinging.

Limited hip motion

As body weight is transferred to the lead leg, a frontal plane motion is generated. If hip adduction is limited, the ankle will try to compensate for the lack of side to side motion.  This will cause the ankle to roll to the side, resulting in increased susceptibility to injury.

Thoracic mobility

As the arm swings, a rotational motion in transmitted to the spine. However, if thoracic spine motion is limited, the rotatory force is transferred through the hip and to the ankle causing an lateral sprain. The force can be magnified if the hip is also tight.

Stay tuned for part 2 of ankle sprains to assess and treat other culprits!

What is 3 dimensional?

Our body functions in 3 basic planes of motion- sagittal, frontal and transverse. Sagittal plane is characterized by forward and backward motion, frontal plane is side to side motion and transverse is twisting motion. Our everyday motions are typically composed of one predominate plane with the 2 other planes used in the supporting roles. An example of this is walking. When we move forward we primarily use the sagittal plane, however the frontal and transverse planes are vital to allowing the proper mechanics necessary to achieve the movement of walking. Without the frontal and transverse planes of motion, more stress is created in the sagittal plane, ultimately leading to injury. Lack of training in the other planes of motion leads to limited endurance and causes premature fatigue.

Visualize the way football players, baseball players, soccer players, etc, move during a game. They step to the side, they step and rotate with every pivot, they twist and turn, all in reaction to the game they play.
Next time you participate in activities such as throwing a baseball or gardening take notice of how our body moves throughout all planes of motion. 

So if our body functions in 3-D, why don't we train in 3-D? 

Examples of 3-D "Jumping Jacks"

The key to minimizing injury and improving performance is to find the exercises which facilitate motion in all 3 planes which is specific to your sport.

Below are videos to show "jumping jacks" performed in the 3 planes of motion demonstrating different variations arm and leg patterns.

Did you think there is only one way to perform "jumping jacks"?