​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.

3D Runner Update

It’s been a while since I’ve written in my blog. 

In the past 2 years, I’ve been focusing on family and running. Juliette is now 2.5 years old, and I’ve ran 3 marathons in 11 months, including Boston.

As far as physical therapy, I’ve grown and developed a lot over the past 2 years. I've been able to incorporate strategies from pelvic floor and neurologic therapy into sports medicine. 

Some of you may know, I’m pretty active on Instagram @3Drunner where a lot of my content lives. To be able to better share information, I’m starting a newsletter. Some of the information from the newsletter will be transferred to this blog, but no guarantees! Sign up HERE to received my newsletter. It'll be all content, no spam. Don't miss out!

I hope to communicate more with all of you!

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.

SaveSave

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.

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!