​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.