Newsletter Archive: Stop Smashing Your ITB

From Newsletter 6/28/2020

I'm so glad you decided to my the 3DRunner team. Here is the newsletter which was send last Sunday! I hope you enjoy it. 

Are you constantly rolling your ITB without resolve? Day after day, you pull out your foam roller, sprawl over the ground, "to make your ITB loose", only to do it again the next day. You've been told to "strengthen your glute". You lunge and bridge and squat, always finding yourself in the same position. You are on the ground rolling your ITB.

Try Decompressing the ITB

When you roll over the ITB, the premise is the smashing the tissue will help it loosen. That's what I've been telling my patients for the past 10 years and my runners, even longer, almost 20 years. If you ask me now, I will tell you something different. DECOMPRESSION. There is a nerve, called the lateral femoral cutaneous nerve, which is the ITB with branches which goes through the ITB. The locations of where the nerve goes through the ITB, is the same location of "trigger points" that I release for my clients and athletes. Nerves really don't like to be compressed. When you compress the tissue surrounding the nerve, it will let go slowly and painfully. When you decompress the tissue, it provides more space for your nerves to move. Your body will tissues will relax as a response.

Here's a photo of the lateral femoral cutaneous nerve from the back view. The white portion on the right is the ITB. The nerve goes through the ITB! The most common tender spot is where the nerve comes out in the middle of the ITB.

What to do?

All right team, you want to DECOMPRESS the area. Use a cup to decompress the ITB to give more space for the nerve. If you don't have a cup, you can use a skin lift technique. Click the pictures below for a link to the videos. Here is the link to the cups I use. (No, I don't get kick backs for sharing this.)

                                                                  Cupping the ITB

                                                            Skin Lift Technique  for ITB 

STOP Squeezing Your Abs AND/OR Glutes

When you squeeze you abs and/or glutes, your pelvis tucks under your body (a posterior pelvic tilt). Referring to the photo below (looking from a front view), a posterior pelvic tilt will bring the top of the photo away from you and the bottom towards you. This position puts tension on the inguinal ligament (which can give you a host of other problems which won't be discussed here). The inguinal ligament has ATTACHMENTS to the ITB. So by tucking your pelvis under your body, again occurs when you intentionally squeeze your abs and glutes, you TENSION your ITB. 

***The circled area is highlighted because those ligaments gets slacked in a posterior tilted position contributing to increase pressure to the sciatic nerve (again, maybe for another post).

So STOP TUCKING YOUR BUTT!

I hope this provides insight into different options besides rolling.

Newsletter Archive: Summer is Coming

Newsletter Archive 6/8/2020

We're already a week into June! When did this happened? There has been so many things going on. 

I would be remissed if I didn't mention the social injustice that is recently in the spot light. I have been listening, watching and educating myself on the different obstacles a Black person has to endure. If everyone is talking, no one is listening. I am listening then doing. For those of you who follow me in Instagram, I have been sharing a bit of information, which for a lack of better words, that has caused a light bulb moment. I am thinking of ways to be more inclusive as a physical therapist. If you are interested, here is a webinar on Anti-racism and Allyship for Rehab and Movement Professionals.

Do You Wear Flip Flops?

It's getting HOT outside. For all you flip flops (sandals, slippers) wearers. I'm sure you've been told that wearing flip flops are bad, but no one ever said why. The reason wearing flip flops can be bad is, your toes curl down to hold on to the flip flop. This will cause over contraction of your toe muscles, especially the muscles of the big toe. The big toe muscle starts at the toe, crosses the foot, wraps behind the ankle and attaches at the outside of the leg. When the muscles over work, it causes poor alignment of the foot and ankle. Here's a video on how to massage your leg.

Exciting News

I'm in the hunt for space to open 3DRunner Performance and Rehabilitation. I'm excited to start the process of finding an in-person location to provide hands on osteopathic techniques for clients. I have mentioned osteopathic in prior newsletters. What does it really mean? To me, osteopathic is taking the consideration of the organs and it's nerves, blood and lymphatic supply, to how they can impact your injury. The picture below is directly from my mentorship with Anna Hartman (IG @movementrev). The slide discusses how the ligaments of the pericardium (container holding the heart) is attached to the spine and the rib cage. When those ligaments are tensioned, it can have a significant impact to spinal movement.

Running Analysis Webinar

I'm hosting a webinar on how to perform a running analysis! If you want to know how to do a running analysis, this webinar will provide you all the fundamentals and more to get started. I will discussed how to set up your camera, identify running form deviations which contribute to injuries, where to draw your angles and lines to show dysfunction and generalized exercises to improve running form. I'm hosting this on Saturday June 13th at 10am PST ( YES THERE WILL BE A REPLAY LINK SENT AFTER THE WEBINAR). The cost is $15. Below is the link to sign up. This is perfect for a runner who is interested, a coach or movement professional. 

UPDATED LINK HERE!!!

Lunge and Squat

I finally started doing what I have been intending on doing for a few years... Instagram Lives.

Here's a recorded session on my favorite lunges and squats. It starts with a few minutes of how to self massage to de-stress. If you want more details check out my last post titled Self Relaxation.

Here's the exercises that I went over:

1) Lunge with Overhead Reach 2) Throwing Squat 3) Twisting Squat 4) Curtsy Lunges 5) Lunge and Reach

I intend on archiving some of the Lives here!

Enjoy!

De-stress Techniques

Learning how to relax can be difficult at times when there are so many things going on. However, it is important to learn how to relax and engage the parasympathetic nervous system ( rest and digest). Your parasympathetic nervous system CONTROLS the sympathetic nervous system ( fight or flight). When there is too much sympathetic nervous system activity, a long list of unwanted side effects can occur such as digestive dysfunction, skin disorders, and high blood pressure to name a few.

A side effect which isn't often addressed is the over activity of the sympathetic nervous system can hinder your body's ability to absorb work. The work can be manual therapy ( massage), a workout or a stretch. Your body is too busy "fighting" to absorb work.

Check out the link below to a self relaxation and stretch to improve parasympathetic nervous system activity.

This was recorded for Instagram Live, please bear through the commentating.

Core: Floor to Standing and MORE

Newsletter Published: 3/16/2020

Grab your popcorn. Grab your snacks. This is a long one. 

Everyone talks about core strength. We all know we need it, wether it's for overall health or improving performance. What does core strength really mean? How do you attain it?

After doing more research on motor development, the consensus is core strength develops from the ground up. Development of core strength from baby to child is what grants us to ability to eventually walk and run. Mastery of one position will be the foundation for the next progression. This forces the body to develop strength in these positions, in all directions, prior to the next movement. Rolling from the back to the stomach develops rotational core strength in a position which our body is most supported by the ground. It is the development of this strength which allows an infant to progress onto hands and knees ( less support) to eventually crawl, which is the next rotational challenge. Until there is appropriate amount of strength in rolling, an infant will not be able to crawl.

What does this has to do with me? An adult? 

We end up being so good at walking however, with various injuries and/or pain we use compensatory strategies therefore losing foundational strength. There is a lot of social media videos showing "extreme" core exercises. You don't have to do that. You may not be ready for that.

How do you know if you're ready?

First and foremost, can you roll? I did a post on this a while back, but it's worth re-stating. Can you roll from your back to your stomach with out using momentum or ANY leg use. Start by bringing your head towards the armpit to the side you're rolling towards. Reach your arm across your body. If your upper body has the proper timing, strength and control, you will roll onto your stomach seamlessly without any leg muscle activation. If you can't roll, start your strengthening at the first exercise below. You may also just practice the initiation of rolling.

Can You Crawl?

Crawling is the next step in the developmental sequence that I like to assess. Are you able to resist rotation on your hands and knees ( in this case, feet)? In this position, your core should be able to remain level as you use opposite arm and leg to crawl forward. The core is weak and/or lacks control when your pelvis rocks up and down or side to side. In my case, shown in the video below, I have a tendency to shift to my right. Umm, it's the hip that has been bothering me for the past 10 years due to a fall. If you have trouble crawling but can roll, I suggest starting at the 2nd video. Yes, it's an "on your back" exercise. It's ok. Start at 1/4 Turkish Get Ups. A resisted rolling exercise will give you the foundational strength needed for crawling.

Exercises Starting from the Ground

The core activation should be gentle. We're looking for your muscles to be REACTIVE. You shouldn't have to think about when to turn them on. Any time you hold your breathe, the exercise is too much for the core. You definitely aren't holding your breathe while you're running. This means your core isn't activating while running. So work on core exercises while breathing. 

Supine Pallof Press

This is where to start if you absolutely can not roll without the use of your legs. When you hold the cable/band from the side, it is pulling you towards the machine. You have to use your rotatory muscles to resist it. The video below shows the knee straightening alternately. However, you can induce a rotation from the bottom by alternating twisting a bent knee turning towards the ground. First, with the feet touching the ground. To progress, lift both feet so your legs are unsupported. 

1/4 Turkish Get Up

 

This is a progression of a rolling exercise from the ground, it adds resistance and decreases the base of support. Be on your back with one knee bent, that side arm is straight and above the shoulder. Bring your legs slightly apart. As you come up, shift your weight onto your forearm then up to your hand. Keep your legs relaxed. The compensatory strategy is to push down or lift the leg up.

Onto all fours!

Once you've gotten the hang out rolling on your back you can mix in exercises on all fours.

 

Above is a series of core stabilization exercises in the hands and knees position. The goal is to maintain control of the core while being able to move the opposite arms and legs. This is where I'AM at. As you can see, adding a band is quite challenging.

Kneeling

Kneel to stand exercises challenges the core muscles because you are moving from a more to less stable position. The resistance should be set up on the side which the leg is forward. This position will induce a rotation in your core. Your muscles has to meet this resistance. Keeping the elbows straight will challenge the core more. For a further challenge, stand on one leg ( the leg closest to the resistance).

Knee Drivers on a Box

The last phase of core development is in standing, the least supported position. This exercise helps to generate power in the standing position and even better on one leg. Hold the cable for resistance and drive the opposite knee up which causes rotation. You body has to generate strength, unsupported, to resist the rotation.

Do you get the idea? The exercises are on a sliding scale. You don't have to perform all exercises in one category before moving on to the next. There are also subcategories of depending on assistance verse resistance. It is very complex and I had to choose the exercises I like and works best, otherwise this newsletter will be a book. It is already is a short story. 

If you have read this far, you're amazing. 

Questions? Comments? Or Concerns? You can always reach out at info@3-drunner.com or DM me on IG @3DRunner

Janet Yiu, PT, DPT, OCS, FAFS 

www.3-drunner.com

3DRunner... Run Free From Injury

​But Can You Crawl?

Newsletter sent on 1/16/2020

In my quest to learn all the things, I have delved into fundamental movement patterns and explored the impacts of skipping developmental milestones. 

Sure enough, this week I had my first patient of the year who completely reinforces what I’ve been researching. 

My older patient comes into the clinic after a total hip replacement. During the assessment, I realized there is poor control of her ENTIRE leg. Her feet are floppy and weak. Her knees are stiff. Her hips are, of course, weak. I asked her what’s going on. She replied, “I’ve been wearing custom orthotics. I’ve had bad feet forever.” I asked, “ Did you hurt yourself as a kid?” She said, “Actually no, I was strong. I even skipped crawling as a baby. Something must have happened.”

OMG. This is the moment I’ve been waiting for. 

I proceeded to tell her what I knew about the developmental milestones. 

The basic movements that we develop when we're babies -- rolling, crawling, kneeling, squatting, and so on -- are the foundation to movement for the rest of our lives. Proficiency of one of these movements is the foundation to the next movement. From there, the movement patterns build on top on one another. From infancy to the toddler stage and through the rest of childhood, we develop these skills progressively. Studies have shown that skipping a milestone as an infant can lead to movement dysfunction as an adult.

In the case of my patient, she skipped crawling. This means she did not develop good push-off with her foot and toes. Since she didn’t crawl, she also didn’t develop appropriate hip flexion drive and opposing arm/leg coordination. Finally, she didn’t develop adequate spine control since she didn’t experience de-weighting of opposite arm and leg (doesn’t crawling look similar to the bird dog exercise often given for core stabilization?!).

With injury, there’s opportunity for these movement patterns to be disrupted. But unlike infants, as adults, we are strong enough to push through the movement pattern without noticing the compensations. This is how injuries continue.

In the video below, I show how having long term core injury (from falling onto my back) disrupts my ability to move from all fours position into a high kneel.

I had a prior injury on my right side hip/thigh from overuse due to change in mechanics from falling onto my back. Going into a right half kneel position from being on all fours is challenging. Swinging my leg forward feels awkward and not smooth. Poor core and hip stabilization from the fall cause my body to find the stability in my legs. To re-establish core and hip drive, I practiced crawling.

After practicing crawling, going from all fours to a half kneel improved. This is important for running because my body has to develop proper muscle movement strategy to move from a more stable position to one less stable. This happens with each step of running. 

You should have seen the look on my patient’s face when I was able to explain her lifelong foot, hip and back pain.

Kinda Deep! If you have questions please email me at info@3-drunner.com or DM on Instagram @3DRunner

Janet Yiu, PT, DPT, OCS, FAFS

3DRunner.... Run Free from Injury.

Janet Yiu

Maximize Your Muscles

Published in the newsletter on 1/2/2020

Welcome to the 3DRunner team!  Please email me if you have any questions!

I have to say, I already love this year. For those of you who may not know, I LOVE even numbers. The fact that 2020 is even and has "round curves" makes me so happy!

For 2020, I'll be implementing a new concept (new to me) which I started testing with my clients at the end of 2019. What is this concept? While performing strengthening exercises, think about the muscle action not the movement. What does that mean? Focus on giving the muscles instructions on how to work instead of giving the muscles the end result. It's about the journey, not the destination! You might have noticed in my Instagram videos, I started giving instructions by having you visualize what the muscle does. For example, in bicep curls "Bend your elbows while visualizing the muscle shortening from the front of the elbow to the shoulder. " Traditionally the instruction is put simply as "Bend your elbow."

What is wrong with just "bending the elbow"?

"Bending the elbow" is not giving your muscle activation enough focus. Sure, there is muscle contraction when we "bend our elbow". However, by PROVIDING CLEAR DIRECTIONS OF HOW THE MUSCLES WORK you improve connectivity from your brain to your nerves then to your muscles.

What do I propose?

I want you to tell your muscles how to contract, provide them clear instructions on how to achieve the motion you're after. This enhances your brain connection from the nerve to the muscles by giving it a clear pathway to the muscles. You wouldn't tell a friend to meet you at the mall without a map or specific instructions (having them Google Map it). Think of this as providing your muscles a map. This helps develop proper nerve pathways to train the muscle to perform the movement with greater ease. As the movement gets easier, different variables can change, like speed or increasing weight. While working on this movement really think about how your muscles contract to attain the action you're trying to achieve.

In the clinic, I often hear therapists and trainers tell patients to squeeze their glutes during a squat. I have witnessed the lackluster results of "squeezing the glutes". Most of the time, the feedback is "I kinda feel it." Simply put, "squeezing the glutes" doesn't give the appropriate signal to the nerves to activate the muscle. What do the glutes do while squatting? As you squat down, the glutes stretch away as the hip bone rolls away from tailbone. To stand, the glutes contract as the hip bone moves back towards the tailbone. Making this connection while engaging the contraction will increase the ability to utilize and engage the proper muscle activation.

Why is this important?

Training your nerves to fire to the muscles is how you will get stronger and improve efficiency muscle recruitment patterns. The muscles can't function without nerves. When you provide instructions to the muscles, you're building bigger and creating more wiring from the brain to your muscles. This will carry over from your strengthening program to your running. The muscles will be able to control the movement vs the movement causing a muscle response. 

TRY IT

Stand and squat without thinking about the muscles. Now, squat with the visualization that your glutes are stretching while squatting down and contracting from the hips towards the tailbone as you stand up. You can try the same cues with bicep curls. Do you feel a difference? This can be the difference in achieving your next PR, or avoiding that pesky injury!

Please email me at info@3-drunner.com or DM on Instagram @3DRunner if you have any questions or suggestions for me.

Janet Yiu, PT, DPT, OCS, FAFS

3DRunner.... Run Free from Injury.

Beyond Clams and Bridges

Here's the first newsletter sent on 12/18/2019

For those who don't know me, here's a brief introduction. I graduated from the University of Southern California in 2010 and have been practicing in physical therapy for the past decade, specializing in orthopedics and sports medicine. Running has been a part of my life since high school. During undergrad, I competed for San Jose State University's DI cross country team and became an assistant coach. I still run competitively for Wolfpack Running Club, a local USATF team. 

When I began my PT career, it was obvious that I needed to marry my two passions, physical therapy and running, so I chose to specialize in running injuries. In 2014, I was at the height of an injury sustained from a fall in 2009. Sick and tired of getting "I don't know" from physicians, I went on my own path to find a solution. This resulted in the creation of my blog, 3DRunner, to provide information that I learned along my journey to recovery. At that time, I was finishing a fellowship from the Gray Institute which focuses on assessment and treatment in all 3 planes of movement, hence 3DRunner. Since becoming a mom 2.5 years ago, I have developed my skills in pelvic floor therapy and am able to translate those strategies into faster rehabilitation time for runners.

I know how frustrating it can be to deal with an injury. With my knowledge as a PT and experience in running, I am able to help guide all runner through any stage of their rehabilitation. 

Enough about me. If you want to learn more about my certifications click HERE. I'm going to move onto glute strengthening.

Are you beyond clamshells and Bridges? 

Glute strength is always #1 on a runner's mind. While clams and bridges are good for strengthening the glutes, they don't translate to running. Being on your side or back, while doing clams and bridges, doesn't stimulate the nervous system enough to make appropriate adaptations. Being on your feet helps to stimulate nerve pathways which work your muscles differently which is more similar to running. Exercises such as clams and bridges target the glutes in isolation. In running, multiple muscles work simultaneously to provide shock absorption, stability and propulsion.

Here are 3 exercises which focus on your GLUTES functionally for running!

Knee Hover Leg Slides

This strengthens the glutes while the leg is working into extension. Being on your hands with knee hovering position recruits the core stabilizers to work with the glutes.

Get onto hands and knees (hands under shoulder, knees under hips.) Activate shoulders by visualizing your triceps pulling the arms into the shoulder joint. Next, hover the knees off the ground. Keeping the back and pelvis level, straighten one leg. Reach the foot away from the body as you use the inner thigh to pull the leg into the pelvis. Return to start position. 

Standing Hip Rotations

Do your knees roll inward while running? This strengthens the hip rotators to help the knee align forward while running.

Put a band or use a cable machine around the knee and place that leg behind you. Keep the knee straight but not locked. Put your hand on your hip to feel the bone turning in and out. Engage the hip by by using your inner thigh muscles to pull the leg up into the pelvis.Turn your thigh in and out while keeping the foot stationary.

Wall Press with Ball

If you kick your ankles while running this exercise is for you! The wall press with ball recruits the glutes while the other leg is moving forward.

Stand next to a wall with your knees bent and a ball (I learn the larger the ball, aka stability ball, the better.) above the knee. Have good stance leg alignment with the foot pushing down (more so the toes) into the ground while the knee is facing forward. Use your inner thigh muscle to engage the hip and pull leg into pelvis. Push the other thigh into the ball. Bring the knee up and down as if you were going through a stride.

Perform 3 sets of 8-15 repetitions

Please email me at info@3-drunner.com or DM on Instagram @3DRunner if you have any questions or suggestions for me.

Janet Yiu, PT, DPT, OCS, FAFS

3DRunner.... Run Free from Injury.