Category Archives: rehab

The Dynasty of Running Medicine Continues

photo 1-11The University of Virginia Running Medicine Conference continues to be the premier source of training and applied knowledge for clinicians across the country. I’ve been lucky enough to co-direct this course with my colleagues Dr. Robert Wilder and Eric Magrum for the past twelve years. We assembled an entourage of experts to bring us up to speed on the latest research, and how this applies to our patients.  And this year, we had requests to expand into talks on performance planning and progression, and we delivered.

From the clinical side:
Dr. Fran O’Connor described findings of “Exertional Rhabdomyolysis”. Its great that the endurance community is embracing strength training. However, going to big too soon can lead to some serious health implications. Dr. O’Connor described how to identify these signs and symptoms when people go a little too aggressively in CrossFit and other competitive environments, and how to ensure that you are progressing training appropriately.

Dr. Wilder described “The Runner With Heel Pain.” Sure your plantar fascia can be the driver of your nagging pain, but there are other structures in this area that drive symptoms, and other areas that can refer to the heal. He reviewed what these are, and how to manage them for success. And on Saturday, Dr. Wilder led a water running lab to discuss tips to ensure high physiologic training stress to maintain fitness while placing the body in a reduced training load.

“The Great Toe” was presented by Eric Magrum. Conservative clinical management of the big toe is essential to proper foot stability. We reviewed normal foot function, problematic scenarios, and how to address each. The one-two punch was saturday’s lab session with hands on evaluation and treatment.

But sometimes, the great toe isn’t so great. Dr Joe Park presented “The Not-So-Great Toe” and discussed the skilled surgical management of the foot and lower leg when conservative care hasn’t worked. Dr Park presented the current state of care for foot management, how this impacts the entire lower quarter, presented some case studies to offer real world application, and innovative, outside the box solutions for correction of serious disorders.

Dr. Siobhan Statuta wasn’t stressed out when she presented “You’re Stressing Me Out! – a review of foot stress fractures.” We reviewed the identification, management, and return to play criteria to ensure successful care.

Dr. John McKnight had some great content (and great pictures) of “common skin conditions of the foot” – we discussed everything from blisters to foot fungus to serious infections, and how to treat these from a clinical as well as a practical approach. Yes, make that one more use for duct tape.

Have you ever wondered what happens “inside” the muscle, and why some tissues sustain strain injuries (tears) more than others? Dr. Silvia Blemker presented the engineering side of the equation. She showed her innovative work with real-time MRI and how the shape of the aponeurosis affects the stress and strain of muscular forces, and how we can learn more in the future in our efforts to prevent injury. In short, muscle architecture matters.

Now, we’ve discussed how to get runner’s healthy, let’s look beyond into the world of performance.

Have you ever wondered what type of cutting edge training principles are employed by Olympic athletes? and why this works? Our keynote speaker Dr. Brad DeWesse identified what constitutes successful athletic performance, and how to cycle your training to achieve it. Sure there’s an “art” to coaching, but is’t it nice when you can make things objective? Brad was able to present data points on values they assess on all their athletes, how they implement training for targeted improvements in the lab, and what kind of outcome this has in the real world. Impact? The US has won more medals in the sports Brad is working with. Its the stuff of genius.

With a formula for successful training in front of us, yours truly provided an overview talk called “Run Better: Clinical, Strength, and Power Prep for Strength and Endurance Athletes.” We identified how to put a better body into your overall plan: how to screen for muscle imbalances that restrict optimal physical development, how to fix them, and most importantly, how to integrate these skills into running mechanics. Following this, I presented real world case scenarios (with data) to show how this impacts both quantitive lab values and race times. Result? Pain free runners that are setting good numbers in the lab and PR’s on the course.

I’d like to thank over 230 physicians and therapists who attended, and about 100 of you who return each and every year. This course almost seems like a small family at this point, and we greatly appreciate your support, enthusiasm, ad feedback each year. Dr Wilder, Eric, and myself wish you success in implementing these concepts with your patients and athletes!

 

“How to Train Like an Olympian” – NBC finds out!

If you want pull a 1080 Japan air in the half pipe, launch yourself 100 yards on downhill skis, or accelerate a bobsled to peak speed before jumping in, science can help you do what you do, better.

NBC came by our lab for a little demo, you can check it out here. (updated with the video link)

Note:  Just don’t ask me anything about curling…….

NPR asked: do smarter shoes make smarter runners?

Brace yourself. You thought heart rate and GPS was cool? The tech revolution is coming to running in a major way. Sure, it’s got some hurdles, but its likely going to be easier than signing up for health care insurance online.

So what if your shoe could tell you about your foot strike ? would it matter? what if you had gear that could tell you about more than foot strike?  What can Tech do for you as an athlete?

Check out this link to listen to the NPR interview for some answers.
And if the merging of tech and athletics intrigues you, check out this article I wrote for Spark/Qualcomm.

Cool technology + smart people to make sense of it = some pretty cool times for you as an athlete.

 

Running around from USATF Nationals to USATF Nationals

Last week, I had the privilege of jumping on a plane and traveling to speak at the USA Track and Field National Conference in Indianapolis. It was a great melding of the minds, with the focus on “rebuilding” the athlete pool. I was asked to speak about injury and trying to reduce injury. My talk was titled: “Solving the mystery of running: practices for sustaining an injury free career.” Given that over half of runners get hurt every year, its a pretty important concept to take a step back and try to STOP this madness. In this presentation we talked about how and why mobility, stability, strength, and power are all unique traits that runners must have, and how these attributes directly transfer to gait. And most importantly, how to improve deficits you’ll find in your runners. So after a day of great discussion, meetings, and networking,  I jumped on a plane back home to Bend, OR.

USATF Nationals to NationalsAnd nationals followed me back home!- This weekend is the USATF National Cross Country Club Championships.  About a thousand runners are converging here in Bend to see which XC Club can take the cake. Local stud, Max King, has organized a challenging course for Saturday. On Friday, I’ll be hosting an all-star athlete panel Q&A featuring: Lauren Fleshman, Besty Flood, Mario Mendosa, Stephanie Howe, and Max King. If anyone wants to ask the best what makes them the best, and gain some scientific insight as to why and how these concepts may make sense for you, come on by – we’ll see you at 4 PM PST at the event expo.  And on Saturday (raceday!), we’ll see you starting at 9 AM for the community run. The REP Lab tents  will have fire pits, hot chocolate, a propane heater, and most importantly – we’ll be hosting a holiday cookie swap!  -that’s right – bake some cookies, trade em out, and eat up. And yes, yours truly will be awarding bragging rights for the best cookie at nationals. Sugar cookies are cute, but don’t stand a chance. To all the potential bakers out there, I’ll give you a hint – don’t bother bringing an entry without chocolate if you really do want to win. And while you are munching, you’ll be cheering as MC’s Jesse Thomas and Matt Lieto calling the races from 10 until 2. And rumor has it there are some after-parties happening ’round town……come see us at the tent and we’ll give you the scoop.

And if you can’t make it to Bend this weekend, Make sure to check out the Runner’s World Google Hangout with Oiselle’s Project Little Wing. The REP Lab is proud that these elite women  call our clinic home for their performance and injury prevention needs.

So this weekend: listen to the experts, eat cookies, and run…..that about sums it up!

Why is stability important for long term athletic success?

Success as an athletes depends on an intact joint, strong muscular support, and specific control from our brain to use the right amount of force for the job. But what happens when our joint is chronically damaged? Is your career over? Let’s take a detailed look at how the body adapts, and even improves with stability training.

Warning: I shot this quickly between patients…..there is some fast talking going on at times…….

Treadmill Running: What’s different? What’s the same?

Well, its that time of year again. The sun sinks below the horizon early, and with that my phone rings with reporters wanting to know what tips they should give to their readers about running successfully on a treadmill. Rather than risking this info getting watered down, I figured I’d give you the straight scoop.

  • Fact vs Fiction: A lot of coaches preach the message “you push yourself over the ground outside, and your pull yourself overground on a treadmill”…..this is 100% false. If you look at the fancy stuff we measure called “ground reactions forces” you’ll see very very similar patterns when running on either surface. The overall mechanics are very much the same.
  • Think about it as a different surface, not a different way to run: despite the fact that the treadmill is very similar to running over ground, there are some differences, and some are actually what qualify as “statistically significant.” But if you look at the clinical impact this has, and if you deal with this type of data every day like I do, the differences are really small. There is a difference in body mechanics running on grass, trail, asphalt, and concrete. But again, these differences are small. As long as you slowly adapt your mileage to treadmill, you’ll be OK. No one runs 100% of their miles on trail and then jumps 100% onto the road. This goes for transitioning miles to the treadmill. Allow a few weeks to transition your mileage over, and your body will adapt to these slight changes.
  • Run correctly on your treadmill: Here’s the most important one. Everyone has a friend who ran on their treadmill and then got hurt. Or maybe it was you. They “blame it on the treadmill” – what happened? First, you need time to acclimate (re-read previous paragraph).  But most importantly, its not running on the treadmill that’s typically the issue. More often than not its running differently on the treadmill. Example. If running outside, you are free to make small fluctuations in speed. On the treadmill, the belt speed is held constant. So if you decide to try to slow down 1%, you can’t. As you get tired, your speed changes, but your cadence slows, which forces a longer stride than you are used to. Your body’s soft tissues are in a completely different position (longer) than you’ve trained them in your previous miles. This longer position can create strains on soft tissues and increase the lever arm on your joints and cause pain. But this really isn’t a treadmill issue – its a running form issue.
  • To incline or not to incline? We often hear to increase the incline on the treadmill to 1-2% to make up for the lack of wind resistance. Here’s the deal. Raising the incline slightly increases the physiological stress level compared to flat, and it doesn’t really change the loads much on the body. In fact, running with a slight incline is actually a bit “safer” for the body since it makes it tougher to over-stride. So no harm here.

What’s a safe way to run on the treadmill?

  1. gradually increase the % of miles you are doing on the treadmill
  2. run the same. Be honest with youself. Are you really running 6:45′s on the road? or are you really running 7:15′s? Aim to keep paces realistic. And aim to keep your stride pretty close to what you typically do. An easy way to do this is by counting your cadence (number of foot contacts per minute). Next time you are running 7 min pace, count your strides. If you are consistently hitting 88 per minute (single side), then aim to maintain the same cadence on the treadmill at 7 min pace. This way you avoid overstriding and the stresses it can place on your body.
  3. Novices: don’t go crazy on speed work. Doing intervals makes you tired. Running faster than 800 meter pace on the treadmill can make it much more likely that you’ll run with compensated form.  In general, I recommend tempo intervals on the treadmill, but speedwork is best done outside. If you must do speedwork on the treadmill, make sure your cadence is similar to what you’d maintain outside.

For those of you who like the fine print, feel free to read more below. And of note, all the information in this article pertains to steady state distance running. Sprint training on treadmills is a different concept entirely. My UVA lab group wrote one, and Irene Davis’ team wrote another. No matter on treadmill or outside – enjoy your run!

References:

Riley PO, Dicharry J, Franz J, Della Croce U, Wilder RP, Kerrigan DC. A kinematics and kinetic comparison of overground and treadmill running.Med Sci Sports Exerc. 2008 Jun;40(6):1093-100

Fellin, R.E.,  Manal, K, Davis, I. Comparison of Lower Extremity Kinematic Curves During Overground and Treadmill Running. J Appl Biomech. 2010 November; 26(4): 407–414.

 

Lesson of the day: don’t hold back

A nice reminder to keep your eye on the big picture, but remember to enjoy yourself….
“The idea is to become an old wizard; to live a long and fruitful life and have a family and be healthy and enjoy the ride. And speaking of the ride, why not let it rip? At least just a little bit. Everyone I know who’s really stoked about getting out of bed in the morning does that to some extent.”
–Laird Hamilton

Road vs. Cyclocross Bike Fit: what’s the difference?

A lot of hype concerning the difference between fitting a road bike and a cyclocross bike could be cleared up if we all agree on two simple things: put the engine in the right place, and then adjust for handling and comfort. Let’s break this down.

Saddle position

Your pedals are driven by large muscles surrounding the trunk, hips and knees. In fact, about 98.8% of the force you deliver to the pedals comes from your hips and knees. That’s right, the ankle only produces a very small percentage of your total power. So it makes sense to have the saddle height and setback (also called for-aft position) the same between your road and cross bikes to maximize power production. Why would you select a saddle position that compromises power output? Keep it simple. If you like your current saddle placement on your road bike, there is zero reason to change it on your ‘cross bike.

Handling and comfort

Good bar position allows you to move around while properly weighting the front end for corners and technical terrain | Photo © Jill Rosell Photography

Good bar position allows you to move around while properly weighting the front end for corners and technical terrain | Photo © Jill Rosell Photography

Okay, now here’s where things are a bit different. Instead of rolling your slick tire down fresh asphalt, you’ve got to contend with dusty pumice, wet grass, rocks, roots, and the nutrient ‘crossers crave: mud! In short, it’s critical to have a good handling front end. This means that you want to have a little less weight on the front so that you can lift your front end over obstacles easier. Careful though, too little weight on the front end will bring your torso too upright make it hard for your front tire to bite and send you skittering wide towards the outside of the turn. Let’s see how this all plays out in fit.

  • ‘Cross bikes typically have a higher bottom bracket. If you were smart, you’d kept your saddle in the same place as your (properly fitted) road bike.  This means that your saddle is higher in the air than your road bike. Since your saddle is higher, your handlebars also need to be higher.
  • Hand-grip placement for optimal handling: A lot of people rarely use their drops on their road bike. Then when on the ‘cross course, they find that they are forced into the drops on steep downhills to brake and get a better grip on the front end. Most riders find the bike is much more stable when conditions get squirrely if they use the drops. So if you are going to be in the drops, make sure you are comfortable.

So what’s the secret recipe to make sense of it all?

It’s simple really; the goal is to get the bars a bit “closer” to you. And you can do this in three different ways. You can run a shorter stem to move the bars closer, you can run your bars higher (by putting a few spacers under the stem or by using a stem with more rise), or a combination of both. I typically recommend that riders start by raising their bars first (because this usually only means moving spacers or flipping a stem). Setting up the bars with some combination of “up and back” will allow you comfortable access to the drops for good grip and handling, and while still allowing you to have optimal engine placement so you don’t lose any precious watts.

Powerful, sketchy, and somewhat comfortable. Yeap; sounds just like ‘cross racing!

Island Power: a case study in athlete development for Ironman World Championships

“Hello- this is Jay can I help you?” After a short sigh, I get a panicked summary of the past several months. A constant battle with shin splints and stress fractures. Not able to run. Rest isn’t helping. Oh and their biggest race of the season – IM Kona- is in 7 weeks. I wasn’t startled. I asked her what her goals were for race day and she said top 10 and a PR in the run. Fast forward through 7 weeks of targeted rehab,strength, and form work. Longest run up to Kona was only 9 miles. Results? She ran a 3:04 and got 10th.

How? It’s actually really simple. For years the triathlete mindset has been that strength and cross training is “something else” to fit in on top of your swim, bike, and run volume. Well, research and successful splits on race day are blowing this myth wide open. The truth? To perform at your limit, its essential to benchmark, and target, your mobility, stability, strength, and power. Instead of just improving your fitness, you can improve you. We didn’t just think outside the box, we threw the box away and re-engineered Linsey’s training in new way to meet her goal. A better you is a faster you.

100% focus during the race, 100% smiles after

100% focus during the race, 100% smiles after

When I saw Linsey 1:40 down with 1.5 miles to go, I knew she could pull through and make a move from 11th to 10th. She had strength and form nailed down solid. Not only did she make the pass, but she made it with over 20 seconds to spare. And I should note that she also maxed out on several of her strength exercises the same week as Ironman. Strong runners = fast (and happy) runners!

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beautiful form, beautiful race course!

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here’s how you start the day in Kona

20131015-032221.jpgMy first, and likely only pic, in Triathlete. Doesn’t this pic look a bit like the “which one of these is not like the other one” song from Sesame Street? Yours truly hasn’t seen 6% body fat in a while…..From left to right: me, Linsey Corbin, Matt Lieto, Chris Lieto, and Elliot Bassett.

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flower power

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Linsey has beer, and it needs transport 1 mile down the road to Bike check on friday…..these are the type of circumstances at which I’m best. Taking resistance training to a whole new level. Ice cold Corbin’s! Get your Ice cold Corbins here!

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some folks will be happiest after IM is over!