Feeds:
Posts
Comments

Archive for the ‘Injury Prevention and Rehab’ Category

Incorporating a Dynamic Warm-up into your Workout Routine

Posted in Biomechanics, General, Injury Prevention and Rehab, tagged , , , , , on March 14, 2011 | Leave a Comment »

*Originally written for the Boulder Triathlon Club as part of their monthly newsletter

Over the past few years, research has shown the adverse effects of static stretching prior to working out.  We grew up thinking and being told flexibility was a good thing, and the best way to attain that was by putting our bodies through a stretching routine before we exercised.  However, flexibility is relative to your biomechanics and activity preference.  If you were a gymnast or kung fu master, you would rely heavily on having flexible and pliable tissue to torque your body in a wide variety of positions.  However, as endurance athletes, we need to have some tension through our tissue to create joint stability, as well as elastic momentum to propel us forward (like the recoil of a stretched rubberband).  Too much or imbalanced tension is obviously an issue that can create strain on the muscle/tendon/ligament, but too little tension or too much flexibility can create instability of the joint.

Now, where does static stretching fall into the realm of proper joint mobility and right amount of flexibility without compromising the stability?  Personally, I think in most situations you can do without static stretching as it tends to fatigue the tissue.  But, if you feel the need to incorporate some aspect of this component into your training program, the best time would be after your easy sessions. The problem with static stretching (meaning holding a stretch for a period of 30seconds to a minute) is that it can reduce eccentric (lengthening) strength and peak force of the muscles for up to 60 minutes following the stretch; you need some tension in your muscles to optimize the elastic component of the tissue during the workout, and by placing a static stretch on tissue that is not already engaged or prepared for that component, the body’s muscle spindles will reflexively activate to resist the stretch.  So, the body can actually become tighter as a protective mechanism when static stretching is performed. Therefore easier effort days would be, in my opinion, the only time to do some sort of static stretching, following your workout, as these days recovery and flexibility should be the goal, not muscle tension for performance optimization.  Prior to workouts (regardless of intensity and duration) and before/after harder and longer effort days, a dynamic routine should be implemented to properly engage and activate the tissue while minimizing the effect the stretch reflex can have.

What do I mean by a dynamic warm-up?  I typically recommend a series of lunges called the lunge matrix (from Coach Jay Johnson, developed by physical therapist Gary Gray) followed by a series of leg swings prior to any exercise.  A lunge, although inherently a strength exercise, is a terrific stimulus to activate all the muscle of the leg prior to working out.  Additionally, drills such as skipping, bounding, body squats, side walking, backwards walking/running, mountain climbers, and karaokes are all examples of dynamic exercises to get the legs prepared for the demands of your workouts.

Read Full Post »

Adding a Hip Mobility Routine as part of the Cool-Down

Posted in General, Injury Prevention and Rehab, Strength Training, tagged , , , on November 2, 2010 | 2 Comments »

It’s been a while since my last blog post and part of that is because I have been consumed with the fall cross country season. This year was my first as the head coach of the Peak to Peak cross country team in Lafayette, Co. It was a pretty exciting season that saw the boy’s team qualify for the state meet placing 12th overall (after finishing second in our region, they were 5th last year) with a ridiculous 25 second pack time, as well as one girl (who had never run cross country before) qualify individually and place 53rd overall. One of the biggest aspects of our training this season was the addition of a number of ancillary routines pre and post-workout with each having a specific purpose or goal. One of those routines is what I called the hip mobility progression. I picked this up from Coach Jay Johnson (he calls it the cannonball cooldown)and modified it for the purpose of making it a mobility routine. The reason I modified his original routine was some of the exercises in the original routine I would consider strength work (which we do in some of the other routines) rather than strictly mobility and because there would be instances when time becomes an issue, so I try to limit each routine to under 5 minutes to make sure we can get in the desired work. The routine that our team does is 20 reps on each leg in the following order: iron cross, scorpions, active straight leg raise, groiners, and hurdle rolls (or hurdle seat exchange from the video). Why do we do this? I look at this routine as a series of exercises to open up the hip capsule while creating dynamic flexibility in the surrounding tissues. Depending on the exercise being performed, there is a certain level of eccentric loading taking place on the hip flexors, hamstring, adductors, quads, and lumbar paraspinals. Additionally, the various exercises help prevent the hip capsule from getting impinged (that can occur during running) while avoiding over-stretching (that can happen during a static stretch where the surrounding muscles are relaxed, reducing their protective control over the joint). We would do this routine about 3 x’s/ week, typically after harder workouts or long runs, as a way to flush the tissue out. As I told Jay, of all the routines that we do, this is the one that I feel had the greatest effect in helping to keep the kids healthy throughout the season. It should also be noted, that I have given this routine to patients in practice who have experienced anterior hip impingement, excessive hamstring tightness, Psoas or Quad overactivity, and TFL/Glut Med/ITB tightness.

Read Full Post »

Training the Transverse Abdominis for Performance: No Need for Isolation

Posted in Biomechanics, Injury Prevention and Rehab, Strength Training on March 8, 2010 | Leave a Comment »

The transverse abdominis and the abdominal obliques make up the abdominal wall musculature that work together in creating a “hoop” stress. This increases stability of the lumbar spine when moving to minimize loads. I was asked the other day, “How important is it to train the transverse abdominis in isolation?” The question was asked because an athlete was witnessed performing a strength routine and was told they weren’t activating their transverse abdominis (TA) by an observer. The observer also suggested that he could train endurance athletes to use this muscle while running to enhance stability. I was amazed and a bit skeptical when I heard this for a number of reasons. How could he tell she wasn’t using her TA? Was he looking for the drawing in or abdominal hollowing motion? If so, then that doesn’t seem like a reliable determinant in observing if this muscle is activating. Also, how does he train athletes to consciously activate their TA when running? If he does employ the hollowing technique, then I would love to see him hold that position when trying to race a 5k. TA training became a fad a few years back when it was found that low back pain patients had a correlation with motor control deficits in this muscle. Therapists and strength professionals began recommending TA isolation exercises using the “drawing in technique” to strengthen and better recruit this muscle thinking that it would enhance stability to prevent the incidence of low back pain. Problem is that it becomes increasingly difficult to hold the drawing in motion when performing multi-planar tasks (like running) and as the abdominal wall stiffens to maintain stability, the abdominal wall muscles bind together. So why perform isolation training for a muscle that acts in accordance with its abdominal brethren? Stuart McGill, probably the world’s foremost expert and researcher on low back and abdominal mechanics, found that the abdominal bracing technique is much more effective than the abdominal hollowing technique as it recruits the obliques in addition to the TA as opposed to the TA by itself. Bracing is performed by creating a co-contraction tightening of the TA and obliques without drawing in or pushing out the abdominals. Try it for yourself: Stand on one foot and have someone push you lightly from behind, using both the hollowing and bracing techniques. Do you have more stability when bracing or when hollowing? It is also important to remember that when referring to stability (and which muscle is most important for this task), it is always relative to a specific moment in time. So when training the transverse abdominis for sports performance stability, it is better to train the abdominal wall as a group utilizing planks, side bridges, and leg extensions from a quadruped position, than trying to train each muscle in isolation.

Read Full Post »

Running while Recovering from an Injury, Pt 3: Seek Advice

Posted in Injury Prevention and Rehab on February 12, 2010 | 1 Comment »

So you’ve modified your training, altered your diet by incorporating more anti-inflammatory foods, and have been icing religiously after workouts, yet you are still running with pain. Now what? It is always wise to seek advice from a healthcare practitioner or coach with knowledge of the biomechanics and injury dynamics of your sport. As I mentioned in a previous post, when injured, one of the body’s responses will be to send scar tissue to the area to bind up the injured area as fast as possible. Innately this is a good thing, the problem lies when the scar tissue lies down against the grain of the injured tissue. Think of scar tissue like a patch of collagen with its sole purpose of pulling together the two edges of the damaged tissue. Problem is, muscle fibers lie in a parallel formation to one another. This is what gives them their explosiveness and power while contracting. However, scar tissue doesn’t care what direction it lies down, as long as its doing its job of pulling together the damaged ends. If left unchecked following injury, a build-up of fibrous tissue can occur, which will present as limited range of motion, weakness, and abnormal compensatory biomechanics that can lead to future injury at the same site or in the compensatory tissue.
Thus, consulting with an experienced individual with knowledge of your sport-specific biomechanics is essential at ensuring proper scar tissue formation/alignment, as well as diagnosis of any muscular imbalances/inefficiencies or abnormal biomechanics that either led to the current injury or that may predispose you for future injury. As Dan Pfaff (renowned track coach suggests here http://tinyurl.com/yhq9fn6) said: consulting with a knowledgeable osteopath or chiropractor that “thinks from the ground up” rather than being “spine guys”, running specific PTs, or functional personal trainers are a few examples of people that may be able to help.
If interested, a few soft tissue treatments I use and recommend for treating areas of scar tissue and fibrosis are Active Release Therapy (www.activerelease.com) and Graston Technique (www.grastontechnique.com).

References:

Pierre-Jean Wipff, Daniel B. Rifkin, Jean-Jacques Meister and Boris Hinz, “Myofibroblast contraction activates latent TGF-b from the extracellular matrix”, Journal of Cell Biology, December 17, 2007.

Read Full Post »

Running while Recovering from an Injury, Pt 2: Anti-Inflammatory Foods

Posted in Injury Prevention and Rehab, Nutrition on February 12, 2010 | Leave a Comment »

When recovering from an injury, healing is a complete body process. So to only deal with the musculo-skeletal component of the injury neglects one of the key factors in determining how fast or slow the recovery process will be. Nutrition is key to ensuring that all the systems working together towards “health” are functioning as efficiently as possible. Say you have a car and you neglect to change the oil, fail to put in the required grade of gasoline, or disregard the engine light when it comes on, but you are really diligent about making sure the car is waxed each week, the tires remain in good shape, and the car is covered at night and in bad weather. Then what are you left with? A care that looks nice but is always at the mechanics having problems and doesn’t feel right when you are driving it. Our bodies rely on the fuel we give them to properly operate the systems we need to heal. If we give them junk, they will perform like junk and will constantly be breaking down. This is especially important when we are injured. When an injury occurs, the body’s response is to flush scar tissue and inflammation to the area. Scar tissue binds up the injured area and inflammation protects the area while initiating the healing response by breaking down damaged tissue. Too much of either one though and additional problems may occur. I will talk about too much scar tissue in the next part of this topic, but for now I will address the inflammation aspect. Inflammation is not necessarily bad, as it is our body’s first line of defense against invading bacteria. But, when too much inflammation occurs as a response to injury, healthy tissue can soon become a target. So controlling the inflammatory response, can help accelerate the healing process by preserving the healthy tissue that remains at the site of injury. Classic ways to do this are ice, elevation, and range of motion exercises (passive, active, and isometric contractions), which acts as a pump to rid the area of excess. Nutrition, however, can also play a strong role in controlling the inflammatory response. A number of foods help fight against inflammation, yet there are also foods that can promote its production. Foods that fight the inflammatory response include: fish (such as salmon, tuna, cod, halibut, bass, trout), nuts (such as almonds, walnuts, hazelnuts, flax seed, sunflower seeds), fruits (such as berries, tomatoes, avocados, kiwi, guava, papaya, cherries), green leafy vegetables (like broccoli, spinach, green beans, broccoli sprouts, alfalfa, garlic, cauliflower), spices (like basil, rosemary, parsley, oregano), and some oils ( like avocado oil and olive oil, not heated). Foods that promote inflammation and are wise to avoid when acutely injured include pasteurized dairy products, caffeine, refined sugars (white sugar, brown sugar, corn syrup), red meats, common table salt (best to opt for unprocessed sea salt anyways), alcohol, processed foods, MSG, and artificial sweeteners. Following some of these dietary modifications when injured will help put your body in the best position to heal.

For more information on inflammatory foods, feel free to email me at r.t.hansen@gmail.com

References:

Wahlqvist, Mark L. New nutrition science in practice. Asia Pac J Clin Nutr 2006;15 (2): 143-152.

Watura, Aoi, Yuji N, Toshikazu Y. Exercise and functional foods. Nutrition Journal 2006, 5:15.

Yuan G, Wahlqvist ML, He G, Yang M, Li D. Natural products and anti-inflammatory activity. Asia Pac J Clin Nutr. 2006;15:143-52.

Read Full Post »

Running While Recovering from an Injury, Pt 1: Training Surfaces

Posted in Injury Prevention and Rehab on February 12, 2010 | 1 Comment »

No runner wants to take time off when training for an upcoming event. But, injuries can occur and when they do, it’s important to know how to properly care for the area to help it heal while still being able to train for your goal race. The following areas should be addressed to put your body in the best situation to stay fit while continuing to heal: 1) Training Surfaces, 2)Supplemental Exercises, 3) Anti-Inflammatory Foods, 4) Seek Advice

1) Training Surfaces -
With every stride, a certain amount of force (ground reaction force) is transferred from the ground and up the leg as your body absorbs the impact to propel yourself forward. The more efficiently your body is at being able to absorb and transfer the ground reaction force, the longer it will take before your body fatigues. When you run however, your body absorbs a repeated impact force of 2-3 x’s your body weight with each stride. Therefore, it is very important to put your body in the best situation to absorb these forces when recovering from an injury. Minimizing downhill running during training can help reduce the amount of ground reaction forces your body has to absorb. High impact forces are associated with an increased occurrence of injuries. When running downhill with a -9 degree decline, impact forces have been shown to increase 108% compared to normal. Where as, running uphill at a incline of +9 degrees reduces impact forces by 65% compared to normal flat surfaces. So when training while recovering from an injury, avoid excessive downhill running and opt for flat routes that incorporate some uphill sections to minimize the impact forces. Additionally, soft surfaces such as gravel roads, hard-packed dirt trails, and low-cut grass fields can help absorb some of the impact forces with each stride. When running on the roads, use caution while opting for asphalt as it still has a little give to it and avoid concrete whenever possible. Appropriate training surfaces are key when trying to recover from an injury, so being attentive at trying to minimize impact forces will help create a more efficient and healthy training environment.

References:

Dixon, S. J., A. C. Collop, and M. E. Batt. Surface effects on ground reaction forces and lower extremity kinematics in running. Med. Sci. Sports Exerc., Vol. 32, No. 11, pp. 1919-1926, 2000.

Hardin, E. C., A. J. Van Den Bogert, and J. Hamill. Kinematic Adaptations during Running: Effects of Footwear, Surface, and Duration. Med. Sci. Sports Exerc., Vol. 36, No. 5, pp. 838-844, 2004.

Hreljac, A. Impact and Overuse Injuries in Runners. Med. Sci. Sports Exerc., Vol. 36, No. 5, pp. 845-849, 2004.

Pepper, M. The Pathophysiology of Stress Fractures. Clinics in Sports Medicine, Volume 25, Issue 1, Pages 1-16

Sole, Gisela; Milosavljevic, Stephan; Sullivan, S. John; Nicholson, Helen. Running-related hamstring injuries: a neuromuscular approach. Physical Therapy Reviews, Volume 13, Number 2, April 2008 , pp. 102-110(9)

Read Full Post »

Posted in Injury Prevention and Rehab on February 12, 2010 | Leave a Comment »

By: Richard Hansen, D.C.

Every run carries an increased level of importance. With the anticipation of race day looming, we try to balance the stress of each workout making sure not to push too much or train too little so we can perform at our best. Staying injury-free during this process is crucial both physically and mentally as we hope to prevent set-backs, meet our goals, and have fun in the process. Injuries happen, however, and are a part of almost every sport. Whether it’s a minor muscle strain or a serious injury, handling the set-back properly is key to staying on track.

So what happens if you do get injured? Running injuries are for the most part due to three factors: environmental or external influences, the runner’s specific biomechanics, and the training methods/workouts utilized. With any running injury it is important to 1) recognize what the injury is, 2) why it occurred, and 3) how to treat it.

Recognizing the Injury:

When identifying an injury, it is important to classify the stage the injury is currently in. Injuries typically fall into 4 different stages: 1) mild discomfort that does not inhibit or affect the ability to run comfortably and only lasts a few hours, 2) discomfort (not pain) occurring during running but still not significant enough to alter the level of training, 3) pain occurring during running that has caused a limitation in the level and duration of training, 4) pain significant enough that running is not possible. Although stage three and four injuries require more active treatment and attention, you should not ignore a stage one or two injury because they can progress to the next stage if not properly cared for.

How did the injury happen?

First you must decide whether the injury is truly running-related or is due to a past trauma that has become chronic and only noticed now when running. When initially evaluating a true running injury you need to determine if is because of your shoes. If injury occurs within 2 -3 weeks of changing running shoes, the new shoe might be the cause and returning to the previous model is the obvious treatment. However, if you have not recently switched to a new shoe, the next question should be: are my shoes worn out? Two important areas to check are the mid-sole and the heel-counter. A compacted midsole in front of the heel and in the forefoot could produce a running injury. Test the degree of forefoot compaction by slipping one hand inside the shoe and the other on the shoe’s sole. Squeeze the midsole between both hands. If the midsole does not noticeably depress, the midsole is compacted. To analyze the midsole at the heel, look at the shoe from behind. If the middle of the heel is significantly higher than the outer edges of the heel, then the midsole of the heel is compacted. To analyze the heel-counter, look at the heel again from behind. If the heel looks like it has been dragged to one side, then it has lost its rigidity and is worn out.

After looking at the wear of your shoes, it is also important to consider whether the shoes are the right biomechanical fit for your running style. Whether you tend to over-pronate, land flat-footed, or have a normal gait cycle, it is important to have the right style of shoes to match your biomechanics. Running shoes are designed to help correct the biomechanical flaws in our individual running styles and encourage a more energy efficient stride. If you are unsure of your running pattern or don’t know what type of shoe is best for you, consult with someone experienced in running biomechanics to help you identify the best fit.

Finally, it is important to consider whether your training methods have changed recently which could help explain the injury. A sudden jump in mileage, an increase in speed work, or a change in training surfaces without a proper adaptation phase can lead to injury. The most common solution is to return to your previous training methods/surfaces and to gradually return the suspected cause after the injury has passed. If all three of these possible causes are addressed, then it is very likely your injury can heal on its own. Simple changes, such as these, can often help around 60% of injuries heal within a few weeks, especially if they are in stage 1 or 2.

If an injury persists, it may be time to consult a practitioner experienced with treating running-related injuries for a more accurate diagnosis followed by a rehabilitation plan.

Read Full Post »

Is There a Right Way To Sit?

Posted in Injury Prevention and Rehab on February 12, 2010 | Leave a Comment »

By: Dr. Richard Hansen, DC

Many professional settings require employees to be seated at their work stations for extensive periods of time. The problem is that prolonged sitting creates an adverse environment for the back. Most workers tend to adopt a slumped or slouched position while at their desks because it takes less effort and energy than trying to sit upright. This, however, creates an increase in anterior spinal disc stresses that can lead to herniations. On the other hand, some employ the use of lumbar supports or ergonomic back rests to encourage them to sit with an upright posture while maintaining the normal lumbar curve. Sitting with an upright posture, though, requires a continuous increased contraction of the spinal extensor muscles, which also impose compressive loading stress on the spine. There have been many research studies performed in an effort to identify the “ideal” sitting posture, without much agreement on what that is. In a study performed by Makhsous et. al, researchers found that sitting with a reduced pelvis support, or a seat-bottom that is angled posteriorly, reduced the peak pressure on the pelvis and helped maintain the normal lumbar curve without activating additional spinal musculature than any other sitting posture evaluated. On the other hand, a separate study by Harrison, et al, found that backrests angled between 110 and 130 degrees with additional lumbar supports have the lowest disc pressures and EMG activity in the supporting musculature. So which posture is best? It turns out that neither one is. Changing lumbar postures throughout the workday appears to be the best strategy to help minimize the risk of tissue overload (McGill). By using a variable posture, compressive loads are constantly shifting from one tissue to another. So the ideal sitting posture is therefore one that continuously changes. Prolonged sitting can lead to back troubles, but practicing the following spine-sparing tips can help reduce the risk of injury while sitting. 1) Use an ergonomic chair, but use it correctly. Typically the chair is adjusted so the torso is positioned upright and the knees and hips are bent at 90 degrees. This posture is good though for no more than 10 minutes. So understand how to change the position of your ergonomic chair so that loads can be migrated from tissue to tissue to minimize micro-traumas on the spine from overload on any single muscle. 2) Take a break and leave your chair. Stand up for 10 to 20 seconds every 10 minutes and maintain a relaxed standing posture. Stretch your arms to the ceiling, which will gently extend your spine, perform neck rolls to relax the neck muscles, and do arm windmills or shoulder rolls to relax the shoulder muscles. The idea is to allow time for the disc material to be redistributed. 3) Finally, find time to perform an exercise routine during the workday. Midday is the most ideal, but stay away from exercising first thing in the morning because at this time of day the discs are the most hydrated and therefore under much higher stresses during bending activities. Thus it is unwise to perform any form of bending activity or exercise within an hour or two of rising.

Read Full Post »

Follow

Get every new post delivered to your Inbox.