Don't be the Hunchback Runner- How to Mobilize the Thoracic Spine

The hip flexors have been getting the spotlight as the evil which contributes to injury. However, the THORACIC SPINE also has a significant influence on injury. The thoracic spine is the area between our shoulder blades. It has a tendency to be stiff because gravity works against our bodies pushing down on our shoulders. Gravity pushes our body down at the shoulder which flexes the thoracic spine. After hours of sitting letting gravity take it's toll, the upper back region stiffens. Think of a hunchback. A flexed thoracic spine limits our ability to stand up straight. Stiffness of the thoracic spine can contribute to injury to the neck, shoulders and low back.

Before and After

Before and After

The pictures above show the side view of the back before and after stretching. There is increased curvature at the base of the neck and the low back.  After stretching, his neck and low back is in a better alignment. Also, there is an improved ability to raise the shoulder. This shows how tightness in the thoracic spine can influence other regions of the body.

While running, the arm swings backward causing a rotation to occur in the thoracic spine. Meanwhile, the same side leg swings forward. The twist of the spine helps to load the core, think of twisting a slinky. However, if the thoracic spine is stiff the low back takes the load. The most frequently injured and degenerated region of the spine is the L5 - S1 (lower back region). Not surprising, this is also the region of the lower back which has the ability to twist the most.

The thoracic spine supports the lower back, and  its bony anatomy allows for rotational movement. However, if the area is stiff, motion is mainly absorbed in L5-S1 leading to overuse injury.
In running, a stiff thoracic spine contributes to injuries of the low back. The overly flexed thoracic spine can limit rib expansion, hinder breathing and limit loading to the core.

Exercises

On top of using a foam roller or lacrosse balls to help loosen up the spine, there are stretches which help mobilize and utilize the muscles.

Use a foam roller across the back between the shoulder blades
 and roll up and down for 2-3 mins

Use a lacrosse ball in the front part of the
chest and move side to side and up
and down for 2-3 minutes

Mobilizations of the Thoracic Spine

Below is a video how how to use arm movements and pelvic motions to mobilize the thoracic spine. These exercises will help increase rotational motion of the thoracic spine allowing increase loading to the core and decrease strain to the lumbar spine. 

I like to follow up mobilizations with strengthening exercises to train the new motion. Please refer the the strength post for ideas on how to train the thoracic spine.

http://3drunner.blogspot.com/2014/07/3d-strength-for-runners.html

These mobilizations will not only enhance mobility for runners but is great for any athlete.

Thanks to Gary Gray at the Gray Institute for the remarkable knowledge.

3-D Hip Flexor Stretching

The detrimental affects of prolonged sitting, especially in office workers, has been the center of much recent discussion. Some have even considered it the "new smoking." Athletes moonlighting as office workers are scrambling to find solutions to counter-act the forces of sitting.  Standing desks and stability balls have been finding their way onto office floors to provide a solution for the standard office chair.


For runners, the number one affect of prolonged sitting is tight hip flexors.  They originate from the back and attach to the hip. The hip flexors are located a couple inches outside the belly button. Tightness of the hip flexor limits your stride length, and contributes to low back pain, knee pain and even foot pain. For example, if your left hip flexor is tight it will limit the right leg’s ability to reach forward, resulting in a shortened stride or forcing the leg to cross midline.  Since the hip flexors attach to the spine, tightness will pull the spine forward leading to bad alignment. Lastly, it can lead to prolonged pronation of the foot.

Here are 2 different techniques on how to stretch the hip flexors. AND on 3Drunner, I'll show you how to stretch them in all three planes of motion.

Hip flexor stretch  #1

Hip flexor stretch #2

*** The stretches should be felt in the front of the pelvis. If you don't feel a stretch in the front of the hips, tuck your pelvis under your body. Another cue is to contract your glutes.

For each stretch perform 10 -15 movements per plane of motion depending on how tight you  feel.

After stretching, your hip muscles may feel a bit funny, loose and wobbly. This feeling is due to the newly stretched muscles not knowing how to control movement. They have been “sleeping” for some time and need to be retrained. In running, the hip flexor muscles are used eccentrically ( meaning they lengthen) so it’s better to work them eccentrically.

Lunge with overhead reach

Perform 5-10 of each of the lunges.


Here's a bonus video on how to mobilize your hip flexors.
Using a ball to roll on the muscle is like getting a massage. This will enhance the stretches and mobility exercises.

Hip Flexor Roll Out

 

A minimum of 2 minutes per side.

Hope this helps. 

Subscribe to my blog to get notified of the next post. UPCOMING: how sitting impacts the upper back. 

3D Calf stretching

With the New Year comes resolutions to run faster, longer and stronger, yet shortly into your New Year's Day run, your foot, ankle and/or knee starts to ache. You're tough and want to stick to your new years goals so you keep going, but what gives? How long is this going to last? Is this going to turn into an injury which may impact your 2015 goals?

For females, our ankles and calves get tight from wearing high heels during the New Year's Eve celebrations. Yes, just those few hours of wearing heels can have long lasting effects on the mobility of your ankle. Males who wear certain styles of dress shoes are also prone to having tight ankles which impact mobility. The limitation in mobility can alter your mechanics leading to ankle, knee, hip or even back pain.

                                   

                                   

Here are a few ways to keep your ankles and calves mobile to help you stay on track to reach your running goals.

Lacrosse Ball Roll 

Compression Band for the Calf

 * a bike tube cut into a long strap and down the center can be used if you don't have a compression band. Use for no more then 2 minutes.

Calf Stretch

I Have Sciatica, Why Are You Grabbing My Foot?

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

So how did this journey begin?

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

What is Sciatica?

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

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

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

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

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

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

             

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

Techniques

Mobility

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

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

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

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

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

So Why Can’t We Recruit our Glutes?

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

We sit a lot!

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

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

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

Bonus Videos on hamstring!

Is All Pelvic Drop Really Bad?

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

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

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

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

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

Do Clam Shells Really Get You Back To Running

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

Clam exercise - does it resemble running?

Lunge with reach - resembles running!

Please refer to the post on strength for functional exercises.

PLAN

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

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

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