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.

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!

Return to Running After Injury and Pregnancy

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

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

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

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


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

Cross country race in San Francisco

My Plan

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

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

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

During this time frame I felt the best that I ever have! Even running in college I had a lot of aches and pains running that distance.
The fitness gained from the first 9 months of 2016 set me up to be able to run 8 of the 9 months of my pregnancy.

Running at 8 month. I could not avoid heel striking!

Post Partum 

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

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

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

Race Day

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

Post race sweaty cuddles

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

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

My Running Analysis

I'm back! Some of you who have been reading my blog may have noticed I took a hiatus. Well, I now have a little to take care of. She is 6 weeks old today. 

I was feeling feeling miserable towards the end of the 1st trimester but able to resume running in the beginning of the 2nd trimester. I ran until I was 7 months pregnant. Then I decided it was time for my body to transition to walking. I resumed running at 4 weeks postpartum . For the most part, I feel pretty good. However, there is a bit of nagging foot pain on my right side. I decided to do my own running analysis. 

Analysis 

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

Why is My Foot Doing That?

During swing phase my right foot turns out more that my left (top photos, a little confusing but the "right" and "left" is for stance leg). This is a sign that I circumduct or "circle" my foot as I swing my foot from back to front. The foot naturally turns up to make sure the big toe clears the ground when the foot makes contact. 

Circumduction occurs due to an improper push off from the ground. This is a result of ... WEAK GLUTES. When the glutes are strong the muscles function to control extension of the femur as the leg pushes back. However, when the muscles are weak, the femurs not properly controlled by the glutes. Due to gravity and weight of the leg, the foot turned outward.

Treatment

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

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

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

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

Please let me know what you think. 

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

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