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

Are you READY TO RUN?

Ready to Run was released in October 2014, and is designed to help runners recover from injury. This book is written by the same author who wrote "How to Become a Supple Leopard," physical therapist and co-founder of San Francisco Crossfit, Kelly Starrett.

"Ready to Run in organized into 3 main sections: the introduction, the 12 standards, and mobilizations. 

Below are the 12 standards which are assessed in order to be "Ready to Run".

1) Neutral Feet

2) Flat Shoes

3) A Supple Spine

4) An Efficient Squatting Technique

5) Hip Flexion

6) Hip Extension

7) Ankle Range of Motion
8) Warming up and Cooling Down

9) Compression

10) No Hotspots

11) Hydration

12) Jumping and Landing

Starrett goes thoroughly details each of the standards by explaining what it means, why it is important and how to fix it. Each standard has a "Runner to Runner" section which is a story related to the topic written by co-author T.J. Murphy. If appropriate, he recommends mobilizations for each of the standards. The mobilizations are strategies on how to improve mobility of the region, and are detailed at the end of the book.

So does Ready to Run really get you running ready?

I allotted myself 3 weeks to work the recommended mobilizations to help achieve Starrett's 12 standards. Below is a sampling of my results. The pictures on the left were taken at the beginning of the 3 weeks, while the pictures on the right were taken after the mobilizations were performed.

Posture - Front view

Posture- Side view

After performing thoracic mobilizations and pectorals soft tissue work, my posture has significantly improved. My back is straighter, my neck is over my body and my shoulders are pulled back. This helps to reduce the stress on the low back, neck and shoulder.

Hip Flexion

I am able to lift my leg higher and with less struggle. In the pre picture my trunk is rounded forward while in the post picture I maintained an upright position. 

Hip Extension

There is more hip extension in the post picture. Hip extension allows better recruitment of the gluteals and decreases stress to the lumbar spine.

Squat Position - Front view

Squat Position - Side view

There is significant change in the pre and post squat position. I am able to get lower and keep my back straighter in the post pictures. In the side view of the pre picture, you can see the stress in my neck from the crinkling in my skin. Also, in the pre picture you can also see the change in the curvature of my lower back.

In addition, I also worked on the other standards by wearing my compression socks, using the compression band ( please see http://3drunner.blogspot.com/2014/08/compression-band-for-lower-extremity.html) and staying hydrated.

Pros

Ready to Run is a great tool not only for runners, but for just about anyone who is looking to improve their mobility. The book is chalked full of information on injuries, mobility and self mobilization techniques.

Born to Run also does a good job instructing readers on how to perform basic mobilization techniques, and helps you take charge of improving your mobility.

Finally, Starrett also does a good job covering other contributing factors such as shoes, compression garments and hydration.

Cons

Ready to Run presents a lot of techniques, and due to the organization of the book it can be difficult to deduce what injuries are related to what specific limitations. As a result, you may end up performing all the mobilizations in the book (which is not necessarily a bad thing, it just takes awhile).

While the mobilization techniques are nicely organized with their own appropriately titled chapter in the back of the book, compression techniques are found within the standards section titled "No Hotspots." This can make the compression techniques a little difficult to find, especially if reading the text as reference material.

Decision

I think Ready to Run is a great tool for beginners and veterans alike. If you would like to learn self treatment techniques in order to minimize and prevent injury then check out Ready to Run.

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!

Compression Band for Plantar Fasciitis, Ankle Sprains and Knee Pain

At the request from multiple people, this post is focused on how to use a compression band (voodoo band) for the lower extremity. The feedback I receive after being wrapped is the treatment area feels lighter, more mobile and less achy. This is does not fix an injury but a way to manage your symptoms.

On the left is a home-made compression band from a bike tube.
On the right, is the compression band aka. voodoo band

How the compression band works

The band works by providing a compression onto the connective tissue. Imagine our connective tissue as a kitchen sponge. When it is being used, the sponge soaks up dirt and grime. When the sponge is compressed the dirty fluid is squeezed out and upon release fresh water is absorbed. By pushing stagnant fluid out and allowing fresh fluid to enter, our soft tissue is lubricated and mobility is restored! Drink Water!

How to use the compression band

Stretch the band about 50-75% and cover half of the prior band. I recommend performing stepping motions in all 3 planes of motion to maximally compress the different aspects of the connective tissue. The band stays on for no more then 2 minutes maximum!


DO NOT use the band if you have peripheral vascular disease, peripheral neuropathy or being treated for cancer. Take the compression band off if the tissue becomes gray, have numbness and tingling or have sudden claustrophobia

The band can be purchased online or you can cut a bike tube in half and split down the middle for a flat band. Note: A bike tube is much shorter then the 7-foot band and you'll smell like rubber.

I will demonstrate on to use the band for the lower extremity - foot, ankle and knee. 
The band can help reduce symptoms associated with plantar fascia, ankle sprains, Achilles tendonitis and general knee pain. 

Plantar Fasciitis 

Start the wrap at the base of your toes and wrap around the foot and onto the ankle. Tuck the end in. You can perform toe curls and extensions, ankle pumps and ankle circles. For the best effect perform a lunge matrix. 

Ankle Sprains and Pain

For ankle sprains, start the band the base of the ankle. Always start the band distal to the ankle to push the swelling into the leg to be absorbed. You want to cover the skin as much as you can so the swelling doesn't get pushed into the uncompressed area. Covering the entire surface around the ankle can be tricky. I recommend completely covering the heel with one circle and angling the ankle down.

This method can also be used for Achilles tendonitis.

Knee pain 

Start the band below the kneecap. You should have enough the cover the entire knee. Tuck the end of the band under the. You can bend and straighten your knee at different angles or contract your quadriceps muscles. My recommendation...  a lunge matrix!

The band can also be used around your muscles such as quadriceps and calf. 

Please see your MD if your pain is a chronic or serious injury.

Those who have use this please comment and give your feedback!

#compressionband #voodooband #kneepain #anklesprain #achillestendonitis #plantarfasciitis # pain 

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!

3D Stretches for Runners

As runners, we have all been exposed to stretches but recently there has been so much controversy. Is it good or bad? Before or After a run? Dynamic vs Static?
Here's my take!

Is stretching good or bad? I will have to argue stretching is good. Stretching reminds our body of the range of motion which is available to us. Sitting through the day promotes tightness in a position which is completely opposite of running.  Stretching restores mobility which increases power. Visualize an old rubber band and the power it generates versus a new, mobile rubber band and the power it generates. The mobile rubber band has more elastic recoil which generates more power. Running efficiently relies the ability to stretch and rebound.

Before or After? It depends on the purpose of the stretch. Performing stretches before a run can give the body the mobility to move with proper mechanics. After stretches I perform a series of light strengthening exercises to load the muscle in the new range of motion.* During a workout muscles tighten due to the chemical waste products produced and micro tears of the muscles during the run. Performing stretches after the run can help increase recovery by facilitating mobility.

Dynamic vs Static? Dynamic! Our body is 3 dimensional, by performing only static stretches  encompasses part of the muscle. By performing motions in all 3 planes of motion more muscle fibers are included in the stretching. There is a time and place for static stretching but for athletes, dynamic stretches help to muscles warm up. Dynamic stretches is controlled movements not ballistic bouncing. 

*Please see my post on strength exercises. Prior to a run, I don't use weight.

I perform these stretches prior to my run about 30 seconds and up to 2 minutes depending where my limitations are that particular day.

1) CALF STRETCH

I used a piece of wood under my toes to increase the ankle angle allowing a deeper stretch. Use your pelvis to drive forward, side to side and twist while keeping the heel on the ground. To focus on the soleus muscle, bend both knees.

2) HAMSTRING STRETCH

Place one leg on a bench with the knee slightly bent. Since the knee is never fully straight in the swing phase of running, I keep it in a relax position and drive my body over my hamstring. Use your hands to drive the body forward, side to side and twist.

3) QUADRICEPS STRETCH

Place your foot on the bench with the knee bent behind you. Tuck your pelvis under your body until a stretch is felt in the front of the thigh. Use your hips to drive forward, side to side and twist.

4) HIP FLEXOR STRETCH 

Place you foot on top of a bench. Tuck your pelvis under your body. Use your arms to drive forward and backwards, side to side and twist. This may be one of the most important stretches to perform if you work at a desk. Hip flexors shorten from prolong sitting but for a good stride it needs to be flexible.

5) GLUTEAL STRETCH

Place one leg on a table  at about mid thigh to hip height depending on flexibility. The knee should be bent to 90 degrees and thigh perpendicular to body (very important!). From there, hinge forward in the sagittal plane, reach away sideways in the frontal plane and rotate towards in the transverse plane to the stretch leg. These motions create length at the hip and pelvic junction. 

6) THORACIC SPINE MOBILIZATION

Rotation T/S stretches- These stretches improve the rotation of the spine.

To improve rotation of the thoracic spine while the arm is swinging forward - Take a step forward with L leg and L arm next to head, bring R arm in front of body and reach forward. 
To improve rotation of the thoracic spine when the arm is swinging backwards - With L leg in front and R arm next to head, swing L arm behind the body.