Tag Archives: UVA Running Medicine

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!

 

a new way to train for running. Lava magazine and Linsey Corbin lead the way

Its not all blood, sweat, and grinding to the same ‘ol tune.

Lava magazine spoke to Linsey Corbin to discuss the innovative things we did together to rehab her injury and get her ready to run Kona. Yup, a 9 mile long run, plus some outside the box thinking = a 3:04 marathon at IM world championships.Check out the full article for the story by Lava. 

Training the old way is boring. Training the new way is faster (and fun!)

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Anatomy for Runners: Top 9 Thought Provoking Books of 2013

Its always nice to get a shout out. Steve Magness is one of the “better thinkers” in the world of running, coaching, and athlete performance, and I respect his opinion highly. Apparently, Steve is nice enough to respect mine as well, and named Anatomy for Runners as one if his “Top 9 Though Provoking Books of 2013″ – thanks Steve. If you live under a rock, and haven’t come across his amazing blog, I highly recommend checking it out: the Science of Running.

And while I’m at it, I’d like to say thanks to all of you who have purchased the book. I teach all over the country, and the number of clinicians and coaches who already have the book, and actually USE it daily on their teams and patients is, well, quite humbling. I know the little niche I operate in will never reach the status of the Harry Potter, but there are over 11,000 of you around the world reading this book over the past year. I hope its making you rethink the way you approach your training, and your patients, your teams, and ultimately producing better results. If you’d like to pick up a copy, click on the link on the right side of the page!

The work of a decade of my career, bound into the "take home version" for you.

The work of a decade of my career, bound into the “take home version” for you.

Brain Camps and Tri-camp: education for you and yours this new year

Happy NY! and with a new year, hopefully comes new stuff to put in your brain. Some of the knowledge below will help with your patients (talking to you MD’s and PT’s) , some will help your clients (hey coach!), and some is for you the athlete ( yup – come spoil yourself in a complete winter triathlon immersion camp here in Bend, OR). Together, we’ll discuss research and concepts that guide our thought process and training, do hands on assessments, drills, and interventions to help us all do what we do better.

Jan 16-17th
I’m headed back home to New Orleans to teach at the USA Triathlon Certification Course. If you are seeking to get certified as a Level 1 coach, or if you are a current USAT LEvel 1 coach and looking to get your Youth Coaching certification, follow this link for details. As a bonus, I’ll be offering a course on thursday the 16th on “Bike Fit for Performance” – of note, you can register for the Bike Fit talk even if you aren’t planning on going to the full Triathlon certification course. Click here for registration info on both.

Jan 25-26
Calling all Physicians, Therapists, and Athletic Trainers: Join us for the Health Running Course in beautiful and sunny Laguna Niguel, CA. Check out the link for an action packed weekend of peer-reviewed clinical knowledge and hands-on sessions designed to help you help your patients. At the end of the day, run along the cliffs and go for a surf. Not a bad place to be in January!

Jan 31st – Feb 2
Athletes, this one is for you. the REP Lab is hosting its first annual Winter Triathlon Skills Camp. We’ll talk shop, you’ll talk to professional triathletes, you’ll outline off-season conditioning plans and strength routines, do swimming form clinics, performance bike fits, and a 3D instrumented runing gait analysis. That’s right – a complete soup-to-nuts guided plan. Bring your 2014 goals, your gear, and a notepad, because we designed this camp to build a better you and a better season. NOW is the time of the year to make things better  - don’t wait until 2 weeks before your first race! More info in the link.

March 7th -8th
Clinicians, this is not to be missed. Join us at the longest running, running-speciifc CME course out there: UVA Running MedicineThis 11th annual event will be a dual focus on foot and ankle mechanics as well as strength and power development for endurance runners, field athletes, and sprinters. We are very excited to have Dr. Brad DeWeese as our keynote presenter this year. As of today- there are a few spots left for the Saturday hands-on lab, so register soon if you’d like to join us (the lab will sell out). Note: this isn’t a simple link – click here, then click on “live conferences” and then scroll down until you see “UVA Running Medicine” – you can download the brochure and register from there.

A lot of time and energy goes into each of these events to ensure that you have the best experience possible –  Hope to see you soon!

 

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.

 

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!

Linsey Corbin’s Lucky 13: kudos from the field

I work with many athletes – and to be honest, I get just as much personal satisfaction seeing a person complete their first 10K as I do helping an elite earn a spot on the podium.  I’m always humbled and honored when athletes seek out my help, and even more humbled when they put out some nice footage such like this as a way of saying thanks.  I’m really just trying to do my job!

Well, professional triathlete Linsey Corbin is also trying to do her job with a stellar performance in Kona 2 weeks from today. Check out Day 2 on linseylucky13.com to learn what Linsey and I have been working on together.

Circles vs. Squares: What’s the best shape for a powerful cyclist?

If there was ever a good topic for an episode of Mythbusters, it would be this: should you pedal circles or pedal squares? We’ve been told that “pedaling circles” is important so that we can apply a smooth even pedal stroke. And word on the street is that this uniform application of power around the cranks is more efficient and makes a better rider.

We’ll lets mock up our own episode of Mythbusters. Let’s pretend that you are doing your thesis on power production in cycling (I did). And let’s also pretend that you are trying to get good data on good cyclists (this was my goal). In my research, I tapped into the best client database I could think of (the US Olympic Training Center). And lastly, let’s pretend that you could examine the pedal cycle of the entire national team, and developmental athletes (I could).  What would you find?

We’ll, this episode of Mythbusters would be pretty clear. World championship and Olympic medals have been won by riders who feature a smooth pedal cycle (circles) as well as cyclists who are mashers (squares). Uh oh. Don’t’ you hate it when real world data flies in the face of what you’ve been told. So where does this leave you?

Spin Scan Pedal Profile: Looking different doesn't mean one is better

Spin Scan Pedal Profile: Looking different doesn’t mean one is better

Its not to say that pedaling style is not important, because it is. In fact, research shows that elite cyclists have better pedaling mechanics than both recreationally competitive cyclists, and even elite triathletes. So if its not the “shape” of the application of power, what does better pedaling mean? Better cyclists have lots and lots of practice turning the pedals over. All this “practice” helps them produce the right amount of force from each muscle, without fighting, or co-contracting muscles during the pedaling cycle. They ride smoother and don’t fight their own pedal stroke. They also can change their pedaling cycle easily when they fatigue, in breaks, or up climbs. Having lots of “strategies” to tap into help as them adapt to the race conditions and terrain they are facing.

The take home:

▪   If you are a rider that has had success mashing your way along at 75 rpm, it doesn’t mean that you must learn to spin at 110 rpm just because someone else does.

▪   Pedaling technique is a variable that better cyclists adjust based on terrain, fatigue, and surface. It is still worthwhile to learn proper pedaling strategies. If you do want to improve your spin, the most beneficial cues are to “scrape mud” off the bottom of your shoe at the bottom of the stroke, and to “kick a ball” at the top of the pedal stroke.

▪   Traction matters. In general mountain bikers have a smoother pedal stroke to maintain traction. If they put all their power around a small part of the pedal cycle their tires spin out.  If you spend time on dirt, emphasize smooth power to keep your tires hooking up  – especially on the climbs.

▪   Better cyclists don’t necessarily pedal circles or squares. They just pedal better circles and better squares – stop reading and go for a ride!

 

 

Spin Scan Pedal Profile: Looking different doesn't mean one is better

Spin Scan Pedal Profile: Looking different doesn’t mean one is better