Resource Library

Staying Healthy and How to Reduce Risk of Injury as a Runner with Kurt Roeser

Boulder Underground discusses injury prevention methods with Kurt Roeser, PT, DPT, OCS in Boulder, Colorado. Kurt is Board Certified Physical Therapist, Clinical Director at Ability Physical Therapy and Founder of Boulder Run Physio. He is highly respected in the running community and has run 1:04 for the half marathon and 2:17 for the marathon. Learn from Dr. Roeser the benefits of strength training, how to reduce your chance of injury and what you can do as a runner to stay healthy. “It can be daunting for runners to choose what supplemental activities they should prioritize to help recover from an injury or minimize the risk of another injury. Focus on the fundamentals: work with a coach to develop a sensible training progression to manage your running load and integrate some basic strength and conditioning. From there you can layer strategies to address your individual risk factors based on previous injuries, biomechanics, or weaknesses. Remember, running should be about running. Keep it simple.” - Kurt Roeser

Why Run and the Biggest Running Mistakes for Beginners with Dr. Caballes

Boulder Underground welcomes Dr. Caballes to a winter workout session in Boulder, Colorado. Dr. Caballes is a Non-Surgical Sports Medicine Specialist that serves the greater Denver-Boulder area through Cornerstone Orthopaedics. He is highly respected in the running community and has been featured in numerous publications including Runner’s World. Learn from Dr. Caballes the health benefits of running, the biggest running mistakes for beginners and what you can do as a runner to stay healthy.

Combined Events Training for the High School Athlete

https://img1.wsimg.com/blobby/go/eaac6d7c-0756-4535-8501-322c7f60eea9/downloads/Combined_Events_Training_for_the_High_School_A.pdf?ver=1578585243962

Recovery and Manual Therapy for Runners with Aaron Lange

Aaron Lange, LMT, specializes in sports massage therapy for elite distance runners. His work includes injury treatment and prevention. He got into massage therapy after meeting his now-wife, elite marathoner, Bria Wetsch. We had a chance to catch up with Aaron to discuss manual therapy and recovery methods for runners.

Stretchy vs. Stiff Runner

Runner phenotypes are important to determine so that training can be tailored to suit the specific needs of each runner.

Basic Nutrition for Endurance Athletes, Part 1

Understanding nutrition fundamentals is key to developing effective fueling habits. Follow along in this series to know what’s in your food and how scientists talk about it.

Read the full article here!

Sleep and Weight Loss

Ever feel like you’re fighting an uphill battle with weight loss? You get up early to hit the gym, you do your best to drink enough water and eat a balanced diet. Yet, find that you’re still struggling to lose weight?! Before you throw in the towel, try sleeping on it!

Research on Sleep and Weight Loss
Evidence1 suggests that men and women who report sleeping less than 7 hours per night are more likely to struggle with weight gain or being overweight or obese. The results of a 24-month sleep study suggested that sleep quality and quantity were both significant indicators to achieving weight loss success in the randomized participants. In other words, the body needs adequate rest in between your daily activities, career and community demands as well as working to digest your food. 

But how much rest is enough? The recommended sleep duration by the National Sleep Foundation is between 7 and 9 hours each night.1 However, sleep duration among children and adults is declining worldwide. This could be a factor for the raising rates of obesity in the United States. The data analysis of NHANES (nationwide demographic researchers) demonstrated a strong correlation between higher BMI (15,16) as well as higher rate of obesity in adults who experienced less than 7 hours of sleep each night and children who experienced less than 9 hours a nights.

Weight Loss and Cortisol
There are several reasons why less sleep can increase the pounds. For example, a study in the American Journal of Clinical Nutrition found that when people were staying up later, late-night snacking increased AND they were more likely to choose high-carb snacks.2 Nutritional science on the other hand suggests that cortisol (a stress hormone) signals your body to conserve energy to fuel your extended waking hours. Cortisol is going to ensure you store extra fat to survive the extra waking hours.

Sleep's Effect on Insulin
Another stubborn hormone responsible for weight gain is insulin, which helps turn sugar into fuel for your cells. When your body is not able to fully process the sugar and starches you eat, it stores them as fat. In fact, researchers found that in a matter of 4 days of insufficient sleep, the body changes the manner in which it processes insulin by 30%. Even when calorie intake remains the same, reducing the rest-period will affect weight loss by 55% if an appropriate sleep schedule is not maintained.

Do note, sleeping more than 9 hours per night will not necessarily help you lose more weight. However, your metabolism becomes dampened when your sleep is interrupted (hello 2 am wake up with a racing mind). Increased cortisol from stress and insufficient sleep as well as decreased insulin are two major factors that contribute to a plateau in your weight loss attempts. If this sounds like you, follow the tips below or set up an appointment to get personalized recommendations to support your longterm healthy weight loss.

Sleep Tips for Weight Loss

• Reduce bright light exposure an hour before bedtime. Shut down your computer, cell phone, and TV for the day.
• Design a restful space and use it only for relaxation purposes. Only two things should happen in your bed room and they’re not working or eating.
• Prepare your mind for rest before your body lays down. Take a warm bath, meditate, or read yourself to sleep.
• Stick to a schedule. Allow yourself to wake up and retire at the same times every day. Do your best to keep this practice on the weekends as well as see a boost in immunity and energy as a result.
• Allow time to fully digest.  Avoid eating meals, caffeine or alcohol close to bedtime. Ideally, when the sun is down, the kitchen is closed. This supports your circadian rythm and healthy digestion.
• Enjoy a dark bedroom. Darkness cues your body to release your natural sleep hormone melatonin, while light suppresses it. Remove lights and electronics from the bedroom and ensure no artificial light comes in through your windows.

The Most Important Muscle

Runner phenotypes are important to determine so that training can be tailored to suit the specific needs of each runner.As more and more information pours out on a daily basis about functional training and as I call "the movement to movement" sometimes information easily becomes misinformation or missed information altogether. One of the central themes surrounding functional training, or at least it should be, is the importance of the THORACIC DIAPHRAGM.

And yes, this does answer the question, what is the most important muscle, and it doesn't matter if you are a sprinter, a marathoner, or any other sport. The diaphragm is central, pun intended, to every athletic movement and the quality of that movement. And yes it is the THORACIC DIAPHRAGM, there are actually 4 diaphragms in the human body; the CRANIAL, CERVICAL, THORACIC, and PELVIC. All of these have played an integral role within the body and between one another. At the foundation of the functional training and athletic training rests the thoracic diaphragm.

First, let’s discuss the action of the diaphragm, the human lungs work on a negative pressure system which essentially means that when we inhale we are essentially forcing air in, and when we exhale we allowing it to escape, this is a very simple explanation but this is not meant to be a physiology lesson. So when we inhale the diaphragm contracts and moves inferior causing a vacuum for the lungs and when we exhale the diaphragm relaxes and rises to allow air out. During these same actions an incredible thing happens, as the diaphragm contracts and moves downward it builds pressure between itself and the pelvic diaphragm or pelvic floor, this is known as intrabdominal pressure or IAP, this IAP is THE PRIME STABILIZER OF THE SPINE! No not the lumbar musculature, not the abs, and not the mystical CORE that everyone is training into oblivion. Now in order for the diaphragm and IAP to properly stabilize the spine and in effect the rest of the body, we must first remember how to breathe.

"Remember how to breathe?" This is a common patient response, and then they lose their minds when I tell them they can keep themselves out of back pain by learning how to breathe. Stick with me, if you have ever watched an infant breathing, not in a creepy way, you have probably noticed that their giant Buddha-like belly expands and falls with little to no movement of the ribs or chest. This is the exact opposite of how 90% of the adult population breathes. Instead most adults, due to extended amounts of seated posture and general lack of movement start to breathe using accessory breathing muscles in the neck and shoulders. These accessory muscles are only meant to be used for labored breathing, as in exercising. Switching to these backup muscles as the main breathing apparatus leads to shoulder tension, lumbar spine pain, headaches, and a whole host of other problems.

Now that we have discussed the general issues with the thoracic diaphragm, we will now move to why it is an athlete’s most crucial muscle. For the purpose of this article, I will use a distance runner, but this does not mean that the diaphragm is not equally important for non-endurance athletes. All runners have at some time probably heard that you should try to breathe in a 3:2 ratio (3 steps breathing in, 2 steps breathing out) this is supposedly done to keep the runner from landing on the same foot with a full exhalation. This theory on breathing is absolutely right, but it needs more specification: 3:2 ratio of ABDOMINAL BREATHING.
I'm sure some of you reading this are saying, what about the glutes, they are the cannon or the powerhouse for running! What about the quads, runners are always getting a bad rap for being quad dominant. What about, what about, what about...all of these are true, but without the ability to properly breathe using the full potential of the thoracic diaphragm, you are working at a poor efficiency level and power output is decreased.

As I stated before when the diaphragm works properly a tremendous amount of IAP is built which acts as a balloon, or better yet as a WEIGHT BELT! Yeah, that giant leather belt used by powerlifters, well for some reason we were built with a spinal stabilizer that beats any bull-skin, the belly-binding belt you'll ever find. When a runner breathes properly through the abdomen, they link the upper body to the lower, they stabilize the spine, thereby stabilizing what is above and below, and most importantly the diaphragm is, in essence, the best shock absorber of the body. I'm going to nerd out for a second but bear with me, when a muscle is eccentrically loaded, like those of the diaphragm when we exhale, the muscle fibers are introduced to almost double the vibrational load. The muscle fibers do this with only 50% muscle activation, but what does this mean. It means that by breathing via the diaphragm, we are muscularly more efficient, and the increased vibrational load capacity means that ground reaction forces are dampened through the entire body. For an endurance athlete, this is a HUGE deal, when we start running marathons or ultras, every step starts to take a toll, so why not get the most out of each stride.

Diaphragmatic breathing does not only equate to increased efficiency but also increased power. If you have ever had the pleasure of reading Anatomy Trains, then you know that the body is now seen more like one giant muscle with multiple fascial pockets, rather than individual muscles encased in the fascia. For those of you who don't know, fascia is the connective tissue that is infused through EVERY structure of the body, it is much like the thin sinew you see in a nice marbled steak. The importance of paying attention to the fascia for training and treatment purposes grows as the body of research constantly mounts. Back to the diaphragm, these fascial pockets or slings connect all parts of the body, but some areas have stronger connections, such as the fascia around the low back, abdomen, and glutes. When we have the cortical ability to relax the abdomen while still breathing properly we allow for a tremendous power transfer from arm swing, to CORE (I just threw up a little), to the glutes, and finally to the ground. I'm not going into a huge amount of details on this but think of it like a bull-whip, yeah the Indian Jones weapon of choice.

The supple leather of the whip is very flexible, with just a small flick of your arm, the power is transferred down the entire length until it reaches the end with enough power to cut that rose in half that your beautiful side-kick has been holding in her teeth. This transfer of energy in a runner cannot happen without this same type of supple energy transfer through the thoracic diaphragm. Sure, good and sometimes great runners, who have poor breathing habits can make it to the peak of running, but this is true for all sports. Athletes are tremendous compensators, and they always find a way to excel, but it is up to practitioners like myself and others in like fields to educate, treat and train people to maximize their performance and decrease injuries.

"When a man has lost all happiness, he's not alive, call him a BREATHING corpse"
-Sophocles

3 Pillars of Ankle Health: Building a Strong Foundation from the Feet Up

Strong athletes have strong healthy ankles! When it comes to movement and force production, our feet are the first thing that comes in contact with the ground. Because of this, ankle and foot health is essential in order to help the whole body move in an effective and efficient manner. Being the base and the place we produce force for jumping and running, ankle strength and stability should definitely have it’s place in your weekly training program. 3 basic pillars of maintaining a healthy ankle include appropriate dosing of strength, mobility, and plyometrics. This will not only improve your ability to produce force in your exercise performance but also in your everyday activities!

Strength
When it comes to performing just about any movement, it costs us some “energy dollars” from our overall energy bank account. Say for example, for every step we take costs 20lbs of energy on your ankle muscles, specifically your calf muscle complex via the Achilles tendon and surrounding tendons. When it comes to taking multiple consecutive steps at a fast rate (ex. running), you can imagine how fast and how much energy dollars we would end up having to use. One way to make sure we don’t ever run out of money (so we can continue doing all the activities we enjoy!) is to build up our energy bank account! What if you could perform a single leg calf raise with 100lbs for multiple reps? Then each time you take a step and it costs 20lb of muscle energy, wouldn’t it seems like chump change? Each step, stride, or jump we take all of a sudden becomes a submaximal effort, and is less taxing as your body requires less energy to complete the task. These 2 exercises below are some of our favorite options for improving strength at the ankle complex!

SL Calf Raises: https://www.youtube.com/watch?v=Mx9uhWJVrwY
Farmer Carries on Toes: https://www.youtube.com/watch?v=EFxgeZeNPqk

Mobility
Having limited ankle mobility in any direction may sometimes hinder your body from performing at their most optimal position. All muscles have an optimal length where they are strongest and able to produce the most amount of force. However, if you are already limited in these positions, your tissues may be forced to try to contract in a shortened, or weaker, position. When it comes to athletic performance, ankle dorsiflexion (foot pointed up) and ankle plantarflexion (foot pointed down) are going to be 2 of the most important positions you want to have access to. If you are an athletes and want to get the most out of your training, add these 2 ankle mobility drills into your movement prep before a leg day or a run for the best results!

Bench Assisted Dorsiflexion (Ankle DF): https://www.youtube.com/watch?v=7_BG3eed6a0
Hero Stretch (Ankle PF): https://www.youtube.com/watch?v=nbFJ_fEfknE

Plyometrics
As an athlete you’re most likely performing some sort of plyometric movement (ex. jumping, running, cutting) that requires elasticity and tendon involvement during force production and force re-absorption. While many HIIT workouts may include some form of high-intensity plyometrics, it is important to perform them outside of these workouts with intent and not under fatigue. By focusing on producing force from the Achilles tendon, you can improve it’s elastic capabilities and “springiness”, which ultimately is another form of building up your overall “energy bank account.” To improve Achilles tendon reactivity, try these exercises while focusing on spending as little time on the ground as possible!

Double POGOS: https://www.youtube.com/watch?v=Ks3JgoDLE6w
SL POGOS: https://www.youtube.com/watch?v=mNqlIcutvDw

Hopefully this gives you a solid starting point of building up some strong resilient ankles. Improving ankle and feet capacity is one of the best ways to minimize risk of ankle/foot injuries in the future. If you are dealing with any kind of nagging ankle or foot pain get in contact with us! We’ve helped HUNDREDS of athletes get back to the activities they love pain free!

How to Incorporate Strength Training in a Run Program

One question we get frequently asked is how to incorporate strength training into a running schedule. From an early age of training, runners are not taught to have a solid strength training program along with their mileage. Starting in middle and high school, other sports have priority, and runners don’t learn how to balance the stress of aerobic (cardio) and anaerobic (resistance) training. They also may never learn proper form and never feel confident to pick up heavy weights in the gym. Fast forward to adulthood, these runners have missed out on the benefits of strength training and how it can make you faster and lighter on your feet.
So WHY is strength training important? 
Having strong muscles makes every stride and movement easier. Your muscles have to produce a certain amount of force to contract, but if you can not only move your bodyweight but EXTRA weight on top, that makes every step you take during running and every squat a sub-maximal effort. Your body learns how to move more efficiency under that extra load. You’ll feel lighter on your feet and stronger doing everyday activities like carrying groceries and going up stairs. Each step during running can exert up to 4x your bodyweight, so it only makes sense to prepare your body to handle those loads! 
So HOW do I run and strength train? 
The answer to this question depends heavily on what your current training looks like and what your goals are. A recreational 5k runner and someone training for a half, full, or ultra marathon will look drastically different, but strength training is equally important for all groups. For someone with a typical training schedule of 3x/week including a long run, tempo/moderate distance run, and short run, heavy lifting should be performed at least 2x/week, allowing for full rest days as well. If you run more than 3x/week, one option is to perform strength training on the same day as the run to ensure you can take a full rest days while adding more running days. Two sample schedules are attached here:
Of course, the days can be adjusted to fit your schedule, but there are a few things to notice in this schedule above. 

• Try not to arrange heavy lifting the day before a long run. 
• Make sure you take full rest days. 
• Make the schedule work for you! 

• Compound Lift Exercises: 3-5 sets, <6 repetitions, 8/10 effort
  • Squat/Deadlift 
  • Sets: 3-5, <6 repetitions, 8/10 effort 
• Accessory Work: 3-4 sets, 6-10 repetitions, 8/10 effort 
  • Hamstring Accessory Work: Hamstring Bridges, Reverse Hyper, Hamstring Curl
  • Plantarflexion Accessory Work: Calf Raises Seated AND Standing 
  • Single Leg Exercises: Single leg RDL, Lunges, Split Squats 
• Power Exercises:
  • Explosive Strength: Box Jumps, Olympic Lifts, Dead Ball Throws
    • 3-5 sets, 2-5 repetitions, 8/10 effort  
  • Reactive Strength: Bounding Jumps, Hurdles, Drop Jumps
    • 3-5 sets, 5-6 repetitions, <5/10 effort 

• Are you trying to get faster? 
• Are you trying to run more efficiently? 
• Are you trying to run farther with less fatigue? 
• Are you trying to maintain a healthy body?

Compensation for lack of ankle mobility

3 compensation pattens you will see for a lack of ankle dorsiflexion .. if you don't get it from the ankle it has to come from somewhere else 🦶 . 1️⃣ Early heel rise 👣 . 2️⃣ Excessive knee extension 🦵 . 3️⃣ Pelvic lean ↖️ . Up next, suggestions on how to fix this mandatory ROM Did you know we offer virtual consultations?! 💻 We love helping people from all over the world move and feel better. 🌍 Our passion is education. Check out our website gaithappens.com for consultations, a whole list of available courses, shoe recommendations, favorite products and more! 👣

Establishing a strong foot tripod

Let's discuss the foot tripod, some hate the term, some love it, 🤷🏻‍♀️call it what you will but that foot best be solid on the ground 👣 You have to feel the ground.  You have to have a stable foundation on which to perch your body 🦶 . And one little fun fact here too…it is the FOOT that PUSHES the knee out, and the hip/glute that PULL the knee out.  So since we have been talking about that knee, if you are squatting, and you hear “sit back on your heels and drive the knees OUT”…..I would be very cautious here.  Most will sit on the outside of that heel, drive the knees out….losing the contact of the medial foot, ie big toe.  And this my friends, is BIG problem. . Find the “tripod”. Find the “4 points of contact”. Find your FOOT 🦶. Good stuff from the DNS Gait course here. . 1️⃣Come up on the toes . 2️⃣Turn your foot in, and press big toe down . 3️⃣Keep the base of the big toe down (POINT OF CONTACT #1) as you spread the 4 toes and drive them out . 4️⃣Anchor the 5th toe toe (POINT OF CONTACT #2) . 5️⃣Keep the big toe and little toe down, and slowly drop the heel . ⭐Be in the center of the heel (POINT OF CONTACT #3, and #4 if you are centered in the middle of the heel⭐ FEEL THE MAGIC HAPPEN, a beautifully strong stable foot.  Now you can squat…..but don’t lose any of those points of contact 😉 . . . Did you know we offer virtual consultations?! 💻 We love helping people from all over the world move and feel better. 🌍 Our passion is education. Check out our website gaithappens.com for consultations, a whole list of available courses, shoe recommendations, favorite products and more! 👣

Sports Nutrition for Females

webinar with Source Endurance
Learn the basics about how the menstrual cycle impacts nutrition and performance. I cover the history of studying (or not studying) females in sports nutrition research, an overview of the menstrual cycle, the basics of what we know about female hormones and nutrition and performance needs, and next steps for those interested in exploring more.

A 7-Day Nutrition Plan to Fuel Your Best 5K Ever

“Runners might eat heaping bowls of pasta the night before a race, but whether or not they're successful the next morning depends on much more than that final bite of spaghetti.
Just like weeks of strategic workouts set you up for race-day success, so too will weeks of thoughtful snacks and meals made up of the right balance of macros and eaten at the optimal times.
Use this nutrition plan as part of our Best 5K Ever Challenge — or alongside your own 5K training — to feel your best throughout the month.”

Read the full article here!

No-Bake Power Bars Recipe

These energy AND nutrient-dense bars are great for travel, long active adventures, and easy snacks.
Ingredients:

• 1.5 cups pitted dates
• 1/3 cup cocoa powder
• 1/2 cup chia seeds
• 1/2 cup coconut, shredded unsweetened
• 1/2 cup dark chocolate chunks or chips
• 1/2 cup oats
• 1 cup peanut butter
• 1/3 cup maple syrup
• 1 teaspoon vanilla extract
• 1/4 teaspoon salt

The Best and Worst Pre-Workout Breakfast Foods

Eating a healthy breakfast before a morning workout can help you feel and perform at your best. But sitting down to the wrong meal can derail your fitness goals and potentially lead to stomach aches and pains and well as indigestion and bloating.

Read the whole article here!

Basic Nutrition for Endurance Athletes, Part 2

Understanding nutrition fundamentals is key to developing effective fueling habits. Follow along in this series to know what’s in your food and how scientists talk about it. Part 2 explores micronutrients, what are they and why athletes need them.

Read the full article here!

Basic Nutrition for Endurance Athletes, Part 3

Understanding nutrition fundamentals is key to developing effective fueling habits. Follow along in this series to know what’s in your food and how scientists talk about it. Part 3 explores specific food choices which boost health and performance as it relates to ideal macros and micros.

Read the full article here!

Running: Expectations v. Reality

So you want to be a runner? Go out, let the sun and breeze hit your face, and cruise down the path without a care in the world. Sounds nice. Maybe you have a race in mind. You’re going to run a local 5K/10K and have a nice after race beer. You’ll get your T-shirt, finisher’s medal, maybe even brunch with some friends on the way home. These are the ideal scenarios, but not always how things play out.

It’s no secret that running is one of the most popular forms of exercise around the globe. Every year, millions of people lace up their shoes and go run. The unfortunate reality however, is that the vast majority of those people wind up injured every year as well. What follows is often worse, those nagging injuries get ignored or trained around and lead to even more issues.

Let’s take a closer look at one of the more popular races, the marathon (26.2 miles).
– There are approximately 30 million regular runners in the US.
– There are over 1,100 marathons held each year in the US.
– ~90% of marathon runners sustain an injury during training.
– Each year, ~80% of runners sustain an injury that forces them to stop running.
– There is an inverse relationship between the cost of a running shoe (the US running shoe industry rakes in about $4 billion a year, by the way) and the likelihood of a runner getting injured. In other words, the more expensive your running shoe, the more likely you are to get hurt. “So which shoes should I buy?” you might ask… Well, that’s a topic for another day. My recommendation for now, just wear what is comfortable to you and don’t worry about the price, brand, features, or what your friend is wearing.

So now you might be wondering, how can you make sure you are able to run without being injured? Great question! Because let’s be honest, telling a runner to stop running is like telling them to stop breathing or telling a fish to stop living in water… That’s just crazy!
There actually is a way for you to run, enjoy it, get good at it and even stay healthy. Our running checklist below is a good place to start.
In this checklist we dive into the 12 essential areas that can impact your ability to run effectively. From head to toe, warm up to cool down, we’ve got you covered. To see our complete list click the link below!
Get Checklist Now

Stay tuned for more running related posts as the weather continues to warm up!
Stay safe & stay healthy, 
Andrew

A Bulletproof Core: Find and Engage the Multifidus

How has your core been feeling lately?  Were you able to find and engage the lower abdominal muscle to give you more support during exercise?  Do you have a better understanding on how to contract your pelvic floor? In this post, we’re going to discuss how to find and engage the multifidus, a key component of a strong core.

What is the multifidus?
The multifidus is a diamond shaped muscle in your lower back that sits deep to your spinal erector muscles. While these muscles are often quick to kick in to help stabilize, they get tight very quickly and can cause  compression in your back.  The  question then becomes – how do we find that deep muscle and activate it?  No worries, I’ve got your back. (see what I did there?)

Finding the multifidus
Start in a standing position and put a hand on each side of your lower back right over those spinal erector muscles.  Lean backwards slightly and feel those muscles contract and tighten under your fingers.  Now, come back up to neutral and tip just slightly forward and you should feel those erector muscles relax; if you keep leaning forward they will tighten back up to support you from falling over. 

Come back up to the point where you feel those erector muscles are nice and soft and sink your fingers deep to feel the multifidus.  From this point, try to come an inch taller without letting those erector muscles get tight. 

Activating the multifidus 
There are a few different ways to activate this muscle. You can either engage by practicing a few different positions or engage as prep before an activity that involves support such as carrying or lifting.

I encourage you to try these exercises and consider incorporating into your overall fitness routine. If you have any questions, feel free to connect with me at amber@physioroomco.com

How to Safely Return to Running Postpartum

Running tends to be a common exercise for moms postpartum because they can take their baby with them, it doesn’t require a ton of equipment and it’s an easy exercise to get back into. However, it’s important to know that your core pelvic floor need to be able to handle the force that is coming from the ground so you can run safely and injury free.

Tight Adductors? Try This

There’s a difference between feeling tight and actually having shorten muscles that are tight. Today, Dr. Amber will help you determine which one you might be experiencing in your adductors, or inner thigh, and if you might just need to get your core working to take some of the load off. Give it a try and let us know what you think!

Post Pregnancy Plank Progression, Part 1

Many core-strengthening exercise programs for woman after having a baby includes movements like Planks - which are great! However, being able to do a plank effectively after pregnancy isn’t always feasible. In this video, Dr. Amber walks you through some plank progressions that will help you begin the process of building up that core strength so you can go back to normal exercise while putting your body in a more optimal position.

Functional foot strength with toepro

Want strong feet? 👣 So do we. And I can tell you since our new obsession with the dynamometer, we are on a mission to break some records with that thing 😉 . Why? Numerous studies show that foot/ ankle strengthening exercise improve balance, provide stability during the push off phase of gait, and as we know provide a foundation for the rest of the body. 👍 Weakness in these muscles can lead to plantar fasciitis, stress fractures, bunions and Achilles tendonitis and multiple other dysfunctions up the kinetic chain. 👎 Weakness in the toes in the elderly is also a contributing factor to an increase in falls. 🙅🏻‍♀️ . Something to consider…..strength gains while exercising are angle specific. To be effective, foot exercises must duplicate the positions muscles are used while 🚶‍♂️ and 🏃🏽‍♀️. We know that during the gait cycle, the toes are at a position of dorsiflexion (upward position) during push off…..SO…… . exercising the toes while they are stretched results in a fourfold increase in toe strength compared to conventional exercises! 🤯🤯 COOL STUFF…..So what does this mean… The short foot, picking up marbles with your toes, banded toe exercises, while all ore a good place to start, if you want to move well, you have to MOVE. You have to make things functional. 😊 . I have been going to town on this thing, and I can tell you, day 1 my foot cramped and I got to about 10 reps and was getting fatigued. Working up to the protocol of 4 sets of 25 reps doesn’t happen over night. But I can tell you, I can’t wait to see that dynamometer read when I can 😁💪 . Modification: roll up a small towel and place under the toes. The foam of this device does provide an increased resistance that is necessary to improve gains however. . https://cdn.shopify.com/s/files/1/256... . . . Did you know we offer virtual consultations?! 💻 We love helping people from all over the world move and feel better. 🌍 Our passion is education. Check out our website gaithappens.com for consultations, a whole list of available courses, shoe recommendations, favorite products and more! 👣

Shoe recommendations for Hallux rigidus

The words NEVER and ALWAYS……ssshhhh 🤫  They’re like swear words, @ least in the world of movement. The big red ❌ and the big green ✅ give us slight anxiety 😬 . We all MOVE differently.💃🏻🕴🧜‍♀️We all adapt to our environments. Yes, there are ways we can move more efficiently, become more stable, more mobile but that picture will look different for everyone 📸 . And, the same for footwear.  We are big pushers of foot function.  We believe the foot should be able to feel the ground, adapt to the environment, be as functional as possible in a world where function is often compromised 👣 . With that being said, gait happens. 🤷🏻‍♀️ And if your gait happened to leave you with a rigid big toe, or TRUE hallux rigidus, or if surgery happened and there is a screw in that big toe, well……shit happens.  So we deal with it.  We work with what we have, and we will find a way🦶 . There are times where that big toe is so rigid, and the forefoot rocker has been lost.  Yes, these cases are rare thank God, but it does happen.  Now, a minimalist shoe is sometimes too flexible for this forefoot. Sometimes this foot type needs some cushion, some rocker 👟 . I am on a FB page for a hallux rigidus group.  It is an amazing resource for these patients.  They share their stories and they share their favorite shoes 😊 . ✔ For a running/walking shoe:  Hoka One One, Bondi. There’s enough cushion on this shoe to handle the weight of the world.  It will provide Cush and rocker to propel OVER the big toe 👣 . ✔For a work shoe: Alegria.  Hello forefoot rocker.  This shoe will rocker you right over that big toe🦶 . ✔ For a sandal: Birkenstock:  RIGID sole.  Patients with foot pain love this sandal.  Why?  It pretty much eliminates range of motion.  Good?  NO.  Good for those who can’t bend their big toe?  Yes 👍 . We caution you, this is NOT an ALWAYS list.  Everyone’s foot function varies, but these have been popular amongst this group 👣 . . . Did you know we offer virtual consultations?! 💻 We love helping people from all over the world move and feel better. 🌍 Our passion is education. Check out our website gaithappens.com for consultations, a whole list of available courses, shoe recommendations, favorite products and more! 👣

What is forefoot supinatus

Forefoot Supinatus:  The correctable one!  We love this one 😊 👣 👣 Quick summary 1. Rearfoot pronation 2. Inability to maintain integrity of the medial column 3. Lateral column SOFT TISSUE CONTRACTURE ⬅️⬅️⬅️ 4. Causes: MANY: But overall… Foot strength leaves something to be desired, and our hip stabilizers are out to lunch 🌮 5. Symptoms: starting at the foot: (asALWAYS 😉) Mortons neuroma, bunions, posterior tibial tendonitis, Achilles tendonitis, ITB contracture, knee pain, hip pain, low back pain, poor balance to name a few 🤷🏻‍♀️ 👣 ⭐⭐⭐DON”T CHASE THE PAIN, FIX THE PROBLEM⭐⭐⭐. Then we can stop diagnosing our ‘PAIN’ 🙌 . 

Forefoot Supinatus Mobility

Remember we're talking about a rigid foot type here so we're looking for mobility 💃 especially in the lateral column of the foot 👍 1. Stand with the lacrosse ball 🎱under the 4th/5th met just behind the ball of the foot 2. Turn both feet slightly pigeon 🕊toed with the knees slightly bent 3. Put your hands on your hips and rotate the pelvis and trunk for about 90 seconds...the ball shouldn't move under your foot 👍👍👍

High Jumping the JAC Way

https://img1.wsimg.com/blobby/go/eaac6d7c-0756-4535-8501-322c7f60eea9/downloads/The_High_Jump.pdf?ver=1578585243962

Lifestyle Factors and Running Injuries

Injuries happen. They’re part of every sport or activity, and typically will happen to almost everyone at some point over their training career. Often when people step into our office, they tell us about the single movement that led to the ache or pain that they are experiencing. Unfortunately, except in the case of significant trauma (ex: NFL running back tears his ACL while being tackled) this is almost never the case. Overuse injuries, or even “tweaks” do not happen in a vacuum. They’re not caused by that one, single wrong movement. They are often caused by many, repetitive wrong movements and choices that could have been improved along the way. But what else impacts the severity or frequency of injuries we deal with?

There are many factors involved in almost every issue we face, and it is hard to determine exactly how much of a role each factor plays. Let’s explore some of the most important ones you should consider. 

Sleep
Prioritizing sleep goes a long way for many reasons and is a crucial aspect of injury prevention. Sleeping accelerates our recovery processes including recovery from inflammation, muscle repair and restocking cellular energy. Aside from being the prime time that our muscles and bones recover from the stressors of daily life, the recovery and rest for the brain and nervous system may be the most important piece of sleeping. Aim for eight hours of sleep per night as getting less correlates with an increase in injury risk. 

Nutrition
What we eat impacts our performance, recovery and how we feel. In general aim to make the majority of what you eat consist of whole food sources with plenty of vegetables and healthy fats. Yes, carbohydrates are important for energy, but don’t forget the protein. Most of the endurance athletes we work with are significantly under consuming protein for their body mass and activity level. For proper muscle recovery and repair we must eat an adequate amount of protein. Our general guideline is to aim for ~1g/lb of body weight per day.

Stress Management
How we manage our stress has a big impact on our ability to have the energy to train hard, and recover well. We all have things that cause stress in our lives, whether it be work, family dynamics, finances, traffic, traveling, you name it. What is important is that we have a strategy around combating these stressors with healthy outlets so that they do not wreak havoc on our bodies and nervous/immune systems. Running is a great outlet! Sleep, nutrition and hydration also impact this a great deal. Have you ever noticed that when you get stressed, you crave junk food? Me too! Unfortunately, the more we give into that temptation the more our body craves that outcome. 

Hydration
Fluid intake is another key aspect to injury prevention and recovery. Adequate hydration helps maintain soft tissue integrity during workouts and also helps clear waste from muscle tissue post workout. Pre and post workout hydration is crucial and coffee doesn’t count! Aim for a daily amount of at least half of your body weight in ounces of water. That’s 75oz for a 150 pound individual. Now, that’s a baseline to hit for everyone, even before factoring in training or activity level. Replace lost fluids in addition to this.  If you are exercising and sweating regularly it is generally a good idea to include some form of electrolyte replacement into the mix. Often, when doing a great job following the guidelines in the nutrition section above, we are under consuming sodium. We recommend sodium supplementation to many of our athletes. 

Movement
It is hard to quantify the importance that daily movement plays on our ability to be resilient from injury. What we do know is that individuals with sedentary jobs or lifestyles tend to lack mobility, range of motion, strength and tolerance to exercise much more than those who are moving often. Take the typical desk worker for example. Yes, it’s true that standing work stations are preferred over sitting, however just this one change alone is not enough! What’s important is to change positions often throughout the day and get our body into different shapes. Think about getting your hips, ankle, shoulder, spine etc. through a full range of motion for a few minutes and then return to your work. Remember, cliches don’t become cliches unless they are true… When it comes to mobility, if you don’t use it, you lose it. 

Before moving on let’s touch on positional errors. What we mean by this is finding ourselves in abnormal or non-optimal positions/postures throughout the day. Examples: standing with duck feet, feet turned outward, sitting in a slumped position over your keyboard or standing with your knees locked out throughout the day. These positions do not serve our tissue and joints well in the long term, though they may provide short term relaxation or stability. The more you can catch yourself and correct these throughout the day, the more natural being in a more optimal position will start to feel and you will tend to bias that way automatically! If you struggle with this, we can help.

Community
Without going down too deep of a rabbit hole – surround yourself with people that support the lifestyle you are attempting to lead. The old adage is that we are the average of the five people we spend the most time around. If you think about who those people are for you, do you like what you find? Your friend group, work circle, and training environment are all things where community and camaraderie make a big difference. Small modifications go a long way. 

We don’t recommend biting off more than you can chew in an effort to implement these things if you find holes in your day. Instead, make small changes, work to be consistent with them until you build a habit. Then implement another small change. 

Until next time, happy training. 

• Andrew

Rethinking Running Injuries – 4 Causes You Should Be Aware Of

In this post we are going to discuss three things related to running related injuries – Why they happen, how to manage them, and what to address to bounce back from them quickly. As we talked about in our last running blog Running: Expectations vs. Reality, running is one of the most common exercise activities in the world. Unfortunately, runners have a high prevalence of injuries with up to 80% of runners sustaining an injury in a given year. This number creeps even higher when we consider marathon running, where nearly 90% of marathoners experience an injury throughout their training cycle!

With advances in footwear and healthcare technology, as well as the increasing knowledge around training and nutrition guidelines, why then do injury rates remain so high in the sport of running?

Let’s explore four causes that lead to running related injuries that you should be aware of.

Training Errors
Training errors generally involve improper progression of the volume or intensity of one’s training. One of the most common training errors is simply doing too much, too soon. In general, the less experienced or conditioned you are the slower the process should be. However, having experience or being in shape doesn’t mean you can skip the process all together. Volume and intensity must be built slowly over time.  

Another important aspect that falls under training errors would be an incomplete training regimen. We often see runners who are missing a proper warm-up, cool down, and strength training program. We all struggle with not having enough time to do all of the things we want throughout the day or the week. Three things to not sweep under the rug when it comes to avoiding a running related injury would be the warm-up, cool down, and strength training routine.

Last but not least, we will touch on the importance of recovery. When we are training hard we have to provide the body with adequate time to rest and recover to reap the benefits of our training load. Building active recovery days into our schedule is an important factor to staying healthy and performing at our best ability level.

Movement Dysfunction
This item boils down to our ability to move our body through full ranges of motion without significant compensations. When discussing running specifically, it is important to focus on the feet, ankles, knees, hips, and spine mobility. Limitations in one or more of these areas will alter our running mechanics and increase the likelihood that we sustain some sort of injury. These issues generally happen slowly over time as a result of not using the range of motion that we are capable of. 

Lifestyle Factors
It is complicated to determine how much of an impact our lifestyle plays into our ability to resist injury. What is not complicated is knowing that it is a major contributor! Which lifestyle factors are most important when it comes to reducing injury risk for runners? Here are a few factors to focus on: sleep, nutrition, stress management, hydration, daily movement, footwear selection, and positional errors. 

In general, the more dialed in you have each one of these factors, the more you will be able to challenge your body without breaking down. Each of these factors are areas that we address with our clients regularly.

External Factors
This section addresses the variables that are out of your individual control. Sometimes injuries are accidents, such as slipping or falling during a run. As a result, we are now in a position to treat and recover from an unexpected injury.

Another external factor we must take into consideration is our competitive nature or the amount of adrenaline we exert. We’ve all had times where we get into the heat of the moment, push ourselves a little harder than we were prepared for, but don’t notice any negative repercussions until after the fact. Remember, the more you prepare your body with the items mentioned above, the less this external factor will play a role in leading to injury. 

We hope this article educated you on running-related injuries and provided guidance in how to best avoid and manage injuries moving forward. 

If you’re interested in discussing this topic in more detail or if you’re struggling with an injury and seeking support, please feel free to call us at 720.316.9974 or email Dr. Andrew directly at andrew@physioroomco.com

Train Smart, Run Healthy: Understanding Training Errors

In today’s post we are going to talk about training errors. Training errors generally involve improper progression of the volume or intensity of one’s training. One of the most common causes of injury is simply doing too much, too soon. In general, the less experienced or conditioned you are the slower the process should be to ramp into training. However, having experience or being in shape doesn’t mean you can skip the process altogether. 

Follow the 10% Rule
If you have taken long periods off from running, your running volume should be built back up slowly over time. General recommendations are to follow the “10% Rule” or to increase your mileage approximately 10% per week over time. There is evidence to suggest that trained runners can advance a little quicker than that, though injury rates increase dramatically as the percentage of volume nears or exceeds 30% week over week.

This is extremely important when it comes to reducing the risk of sustaining an injury, and one of the first questions we ask our clients. Generally, our cardiovascular fitness improves more quickly than the body tissues can keep up with, which makes it challenging to hold ourselves back. The primary reason to progress gradually over time is to allow the tissues to adapt and build our structural integrity. This means our muscles, joints, bones, tendons, ligaments, etc.

Develop a Complete Training Routine
Another important aspect that falls under training errors would be an incomplete training routine. We often see runners who are missing a proper warm-up, cool-down, and strength training program. We all struggle with not having enough time to do all of the things we want throughout the day or the week; though these three things should not be skipped. 
While strength training builds tolerance in our tissues to the rigors of running, warm-ups are pivotal to priming the body for the movement and strain you’re about to endure. Cool-downs on the other hand normalize tissue function through movement while reducing heart and respiratory rate. 

Recovery
Last but not least, we will touch on the importance of recovery. When we are training hard we have to provide the body with adequate time to rest and recover to reap the benefits of our training. Building active recovery days into our schedule is an important concept.

In high level running it is not uncommon to see training schedules that involve running all seven days of the week. For most people, we do not recommend this, but rather scale the frequency back to 5-6 days at most in order to reduce injury risk. That doesn’t mean you should do nothing on those other days of the week. Continuing to be active, work on mobility drills, or resistance training would be good uses of your time when you are not running. Even when you are training consecutive days throughout the week, each training session should not be extremely taxing. One of the sure fire ways to increase your risk of an injury is by trying to make every run intense. Variety in training is important to allow you to continue training for a lifetime.

What Is Your Core And How Can You Activate It?

Have you been told to “turn on” your core when you exercise? Do you struggle to understand where these muscles are and how to effectively activate? If so, you’re not alone. Let’s discuss what your core is and how to activate so you can become stronger, healthier, and more resilient to injury.

What is your core?
What muscles do you think make up your core? There are a lot of muscles in the abdominal area that are considered part of the core. The main purpose of the core is to provide stability without limiting mobility.  If you contract the upper abdominals and then try to bend backwards, you will find it hard to complete the same range of motion if you were not contracting these muscles.

The four muscle groups that make up the core are the transverse abdominis, the multifidi, the diaphragm, and the pelvic floor. The purpose of these muscles is to support you while you move and to manage the pressure within your abdomen and pelvis while you perform different activities. When these muscles are not working optimally, symptoms such as low back pain, urinary incontinence and difficulty progressing with movements may develop.

How can you activate your core?
1.) Focus on the transverse abdominis
To activate, you may have been told to suck your belly button in towards your spine or rotate your pelvis so when you are laying on your back you flatten your spine into the floor. While these are good tips, I tend to find that they often cause you to over contract and engage extra muscles. The cue I prefer is to “bring your hip bones together”.  While you won’t actually generate any motion, this helps to bring the contraction lower in your abdomen and keep your upper abs and glutes from overpowering.  If you bring your fingers about 2 inches in towards your belly button from your hip bones, you should feel this area firm up without pushing up with the contraction. 

2.) Focus on the pelvic floor
While it tends to be talked about more with females, both females and males have a pelvic floor. However,  the anatomy changes slightly and therefore, cueing on how to activate is adjusted.  The one cue most people are used to hearing is to stop the sensation of having to use the restroom.  This direction may cause you to over engage and can lead to bladder dysfunction. 

To engage these muscles, you want to stop the sensation of flatulence, and “zip” that contraction forward.  This should be a gentle contraction and you should feel supported without feeling like you are working too hard.  You can then add the above transverse abdominis contraction to create a well-supportive sling.

I encourage you to try these exercises and consider incorporating into your overall fitness routine. Stay tuned for part two of this blog series, which will cover the remaining muscle groups that make up your core. If you have any questions, feel free to connect with me at amber@physioroomco.com

What Are The 7 Most Common Running-Related Injuries?

As humans, we were built to withstand running for long periods of time at various speeds. However, this highly repetitive activity inherently involves a significant level of impact, leading to a plethora of injuries. Have you met a runner that hasn’t dealt with some sort of injury? Odds are you haven’t. The majority of injuries that runners sustain involve areas ranging from the lumbar spine (lower back) to the foot.

The seven most common injuries runners experience include the following:

1. Runner’s Knee (AKA patellofemoral pain syndrome, or PFPS)
2. Achilles Tendonitis/Tendinopathy
3. Hamstring Issues
4. Plantar Fasciitis
5. Shin Splints
6. Iliotibial (IT) Band Syndrome 
7. Stress Fractures

Psoas, Back, Tailbone pain

This release allows for self care in the low back and pelvis. 
Women: if the pain persists, particularly around a cycle of the month, Contact your OBGyn as it can be a sign that there is something more going on. The Uterus and Cervix both refer pain into the tailbone. 

Why Pain can become Chronic

Every nerve has an action potential 
People with Chronic pain have a lower threshold before the Action potential stimulates the pain response. 

What is Laser THerapy

Class IV laser can be a huge advantage in the recovery process from injury. 

Essential Oils

Essential oils have a multitude of uses. They can be important in overall cellular health, immune system protection, Detoxification, and a clean home. 

Improving Your Squat - Part 1

Improve your squat with Dr. Andrew Fix of the Physio Room! This is the first in a 3 part series. 

Lower Leg Mobilization For Runners - Anterior Tibialis

The anterior tibialis! If you've never spent time on this muscle in your lower leg and you're a runner.. well, you just might want to start! Too often we give our quads and calves most of the attention and we miss other areas of the lower leg.  Dr. Andrew will walk you through this simple anterior tibialis mobilization! Give it a try. 

90/90 Hip Stretch

The 90/90 hip stretch is one of our favorite hip mobilizations for after exercise and especially for our runners out there. Get into the routine of doing this one and you will steadily improve your hip mobility, keep those hips healthy and decrease risk of exercise or sport related injuries down the road.

Why you should STOP rolling out your IT band with Dr. Andrew Fix

Rolling out your IT band isn't necessarily a bad thing.. but we find that most people actually don't need to focus on this area to solve the problem they're trying to fix. The problem is likely stemming from your TFL upstream. In this video, Dr. Andrew will explain why this is more effective and why you should stop wasting so much of your time on your IT band.

Hip Strengthening Exercise for Lower Back Pain / Hip Pain / Knee Pain

This is a great hip strengthening exercise that we like to give many of our clients that experience lower back pain, hip pain, knee pain.. or maybe they're cyclists, runner or sit at a a desk all day. So really, this exercise can benefits almost everyone. All you'll need is a small band! This exercise will strengthen your hip flexors which is going to make it easier when you're running, cycling and might even help reduce some of that tightness you feel in the front of your hip.

Great Lower Body Exercise For Runners With Dr. Andrew Fix | Physio Room Co

Are you a runner and looking for some lower body exercises to strengthen your ankles and calves? Try this exercise! It's called the "Hover Walk".

How To Strengthen Your Calves

We’ve talked about how to stretch the calves (check out previous videos if you missed it) but today is all about strengthening those muscles! So find a slightly elevated area and give these exercises a try!

How to PROPERLY stretch your calf!

We have two sets of calf muscles; the gastrocnemius and the soleus. The gastroc is the muscle most of us think of as our calf and the soleus is a longer muscle that runs underneath. When we stretch the calf we want to make sure we're targeting both muscles because they both come together to form the achilles tendon. In today's video, Dr. Andrew will walk you through how to properly stretch both calf muscles!

Dorsiflexion & Plantarflexion Ankle Mobilization (No equipment needed)

Today’s ankle mobilization can be done exactly where you are with no equipment so kick off your shoes & go through this one with us! This technique will improve ankle dorsiflexion (the ability to bring your toes closer to your shin) as well as plantarflexion (pointing your toes forward). Both are important for proper ankle function and stabilization!

Lock In Your Mentality

The final piece to our Ready to Run Checklist is to find your lock in mentality! We're talking about the mental aspect of your training. What are the things you're doing to prep yourself mentally for your run? If you have a system set in place for yourself, you have a much higher chance of setting yourself up for success on your runs. Not only will you be in the right head space but you'll get a better quality run in. Allow Dr. Andrew to explain further in this video and be sure to check out the rest of our Ready to Run Checklist if you haven't done so already. Each video is packed with valuable information that could really improve your running.

Strength Training For Runners

Is strength training important for runners? Yes, absolutely! It will improve your running ability, make you more resilient to injury, improve your running economy resulting in you running faster and you'll be able to run longer feeling better. Allow Dr. Andrew to take you through our recommendations when it comes to strength training.

How to Properly Warm-up & Cool Down for EVERY Run

One of the best ways to not only prevent injury when you run but to simply run more comfortably is to go through a proper warm-up and cool down before and after every single run. Most people believe the first mile of their run is their warm-up but there are a few exercises you'll definitely want to add to your warm-up routine to better prepare your body for the repetitiveness of running. The good news is, it really only takes about 5 minutes. Dr. Andrew will take you through his full warm up routine as well as cool down so you can feel your absolute best the next time you head out on your run.

Training At Your Pace

Today is all about not comparing yourself to the person next to you and training at your own pace. Often times we push ourselves harder than our bodies are ready for and increase injury risk when we run because we're trying to keep up with a pace we're not yet ready for. This helps us to train smarter. Allow yourself to improve over time but remember to stay at YOUR pace, not someone else's.

Progress Slowly With Your Training

Welcome back to our Ready to Run Checklist with Dr. Andrew Fix. Today’s video is about knowing what you are and are not ready for when it comes to your running routine or training. This idea of progressing slowly just may be the most important item on our checklist. In this video, Dr. Andrew will provide you with some general recommendations you can use to decrease your risk of a running related injuries.

Proper Head Position When Running

Believe it or not, your head position when you run can either make you a more efficient runner or a less efficient runner. In today's video, Dr. Andrew will walk you through a drill that will allow you to better control your head position. Apply this principle to your next run and notice how much more efficient you feel.

Spine Mobility

Today is all about SPINE MOBILITY and why it's actually pretty important for runners!

Hip Mobility & Squats

Welcome back to our Ready to Run Checklist with Dr. Andrew Fix. Today is all about hip mobility and squats. Can you squat with full range of motion? Are your hips too tight? Are your glutes firing? We'll discuss that and more in today's video as well as give you a test to see just how good your squat mechanics really are and if your hips are what's actually holding you back.

Ankle Mobility

Welcome back to our Ready to Run Checklist with Dr. Andrew Fix - today is all about ankle mobility and this is important because anyone that does activities on their feet (which is almost everyone) needs adequate mobility in their ankles for going up and down hills, stepping on and off curbs and sidewalks, the list goes on. If we don't have proper mobility here then we can be setting ourselves up for problems.

Bracing Your Spine

Welcome back to our 12 part Ready to Run Checklist series! In today's video we talk about the importance of bracing your spine when we run. Common faults we often see in runners is an over-arched lumbar or a rounded thoracic spine and we lose that relationship between our spine and hips.

Foot Mobility & Strength

Welcome back to our 12 part Ready to Run Checklist series! In today's video we talk about the importance of foot mobility & strength as it relates to running as well as give you a few exercises that you can do on your own to improve overall foot function.

Listen To Your Body

Welcome back to our 12 part Ready to Run Checklist series! In today's video we talk about the first item on the checklist; Listen to your body! This is such a key component to training whether you're training for a running event or training in general.

Post Pregnancy Plank Progression, Part 3

Part 3: At this point you should be ready to move into the final plank progression. Dr. Amber walks you through the correct way to hold a plank to decrease your risk of over-compensation and put you in the best possible position for maximum core strengthening. She will also show you ways to modify this final plank position if you still find it to be difficult. If you're interested in a one-on-one session with Dr. Amber please reach out at amber@physioroomco.com

Post Pregnancy Plank Progression, Part 2

Part 2: Many core-strengthening exercise programs for woman after having a baby includes movements like Planks - which are great! However, being able to do a plank effectively after pregnancy isn’t always feasible. In this Part 2 video, Dr. Amber walks you through more plank progressions that will help you begin the process of building up that core strength so you can go back to normal exercise while putting your body in a more optimal position.

P.E.A.C.E & L.O.V.E = An Updated Guide for Soft Tissue Injuries!

If you’ve ever hurt yourself or sustained an injury, you’ve probably read somewhere on Google or heard a coach or doctor tell you to implement the method “R.I.C.E” (Rest, Ice, Compress, Elevate) in order to combat these soft tissue injuries and facilitate our bodies’ healing response. While this was meant for the acute phase of the injury (meaning JUST the first 24-72hrs), unfortunately we still see tons of people being misguided and utilizing this method weeks or even months into dealing with an injury!

In the British Journal of Sports Medicine (BJSM) in 2019, Dubois and Esculier proposed an updated acronym of “P.E.A.C.E and L.O.V.E” to assist in the management of musculoskeletal injuries through both the acute as well as subacute phases.
P.E.A.C.E. (acute phase) – AKA: Calm Shit Down

• P = Protect
  • Initially after the injury, we want to protect the aggravated area by temporarily avoiding and unloading movements or exercises that provoke or increase discomfort. Usually movements that cause any kind of sharp pain should be avoided or modified in the first few days after the injury. While protecting the site of the injury, it is important to MINIMIZE REST and continue to find different ways to move in order to prevent overall deconditioning!
• E = Elevate
  • Elevate the injured area higher than the heart.
• A = Avoid Anti-Inflammatory Modalities
  • Avoid NSAIDs and Ice!
  • Inflammation is our bodies natural way to combat the injury and help facilitate optimal soft tissue regeneration. Utilizing medication or ice to inhibit the inflammatory process can actually impair and slow down the healing process. The use of ice is mostly an analgesic one as it can assist with temporarily numbing the sensation of pain. However it is important to note that ice may potentially disrupt and delay the healing process of our body.
  • Our bodies are extremely strong and resilient! Let your bodies do what it’s designed to do without impairing the natural process!
• C = Compress
  • Utilizing elastic bandages or tape can assist with reduction of swelling (if there is swelling)
• E = Education
  • Understand that passive therapy approaches (manual therapy, e-stim, ASTYM, Graston, dry needling, cupping, etc) has a minimal effect on pain/function when compared to an active approach
  • Understand and set realistic expectations based on healing time frames depending on the severity of the injury

• L= Load
  • Use an active approach and load the tissue with the issue! Let pain be your guide to allow for appropriate tolerable loading. Early loading has been shown to be extremely beneficial to help you get back to your normal activity and life pain free again!
• O = Optimism
  • Perception and how we view situations are extremely important as our brain plays a significant part in the rehab process! Research has shown that individuals with negative expectations are more likely to have worse outcomes than individuals with positive expectations. Set yourself up for success by viewing situations through a positive lens and outlook!
• V = Vascularization
  • Movement is medicine! Blood flow is extremely beneficial for accelerating the healing process. Pick pain-free movements that you enjoy and perform them often!
• E = Exercise
  • Utilize an active approach in order to restore mobility, strength, stability, and proprioception to the area. This will not only help accelerate the healing process, but also help reduce the risk of a recurring injury!

Why The IT Band SHOULD BE Tight

The IT Band is often times a commonly misunderstood area of the body. We often see the general public encouraging athletes and runners to foam roll and stretch out their IT band in hopes of increasing the length and pliability of the IT band, thus hopefully decreasing the discomfort or pain the athlete may be experiencing in their lateral thigh. In this article, we’re going to discuss the function of the IT Band and why it actually should be “tight” in order for it to be strong and create stabilization at the hip, knee, and thigh for athletes.

What Is The IT band and It’s Function
Before we discuss anything, we need to understand the IT band structure itself. The IT band is a structure along the lateral leg stretching from the hip to below the knee. It connects up top on the hip to both muscles and bones and has multiple attachment points on the thigh until it connects to both the knee and shin. The purpose of the IT Band is to stabilize the hip and knee joints through dynamic motions such as acceleration and deceleration. Over time, because of it’s function, the IT Band has actually adapted to become STIFFER in order to help us stand upright, and interestingly, DECLINES in stiffness for sedentary folks. Even more interestingly, horseback riders actually develop a similar structure along the inside of the thigh to adapt to stress patterns with saddle contact and riding. That’s just how adaptable the ITB and the human body is! So, if you are an athlete and typically a more active person in general who is putting more stress through their legs, (ex. runners and field sport athletes), you are naturally going to have a stiffer and tighter IT band in order to be able to support and be able to handle the dynamic forces going through the hips and knee.

Common IT Band Myths

1) IT Band Pain is Due to the IT Band Being Tight
Often times, is very common for runners with a high volume of downhill runners, or new runners to develop some lateral knee pain or tightness commonly attributed to the IT Band. In the past, people have commonly thought the IT band to be tight, and caused friction over the distal IT Band, thus leading to people to stretch and roll out the IT band as a treatment. However, we know that there is a fat pad with a ton of blood supply and nerve endings right where most people feel pain, which makes sense why the distal lateral end of the IT Band is commonly sensitive. This fat pad is meant to protect other sensitive tissues and maintain joint lubrication in high-stress areas like the knee. If it is compressed too much these nerve endings and blood supply are disrupted and pain is felt.

Therefore, if we already have an IT Band and lateral knee that is already aggravated, smashing or trying to “stretch” the already sensitive area would only aggravate and piss off the area even more. We also know that as a runner or athlete, the IT Band gets tighter and more stiff as a natural adaptation of our body in order to withstand the loads seen with higher impact activities.

2) You Can “Lengthen” and Physically make changes to " IT Band
Even if we were trying to “lengthen” and elongate the IT Band, we physically cannot. A study by Chaudry et. Al found that extremely large forces (>9,075N) were required to produce 1% change in fascia. That is basically the equivalent of hanging a F150 pickup truck off your IT Band! So the chances of us trying to achieve forces that high in order to “break adhesions” or “stretch” out our IT Band with a foam roller or stretches aren’t realistic.
Stretching or manual therapy may lead to relaxation changes and sensory changes that are due to stimulating receptors changing the overall tone of muscle, not necessarily creating a physical lengthening effect of the tissue. Stretching, laying on a table having someone massage you, or using a foam roller may temporarily feel good but there isn’t any solid evidence that any of these things create long-term soft tissue changes making them more pliable, less tight, and less painful.

How to Address IT Band Pain

1) Address load management
When one is experiencing IT Band Pain, we typically want to take a look at the workload volume around the same time that their symptoms started flaring up. Was there a sudden increase in running volume? Was there a sudden increase in squats or lunges in the programming? Was there a change in the running environment such as increases in uphill or downhill running or changing surfaces from concrete to trail. One of the many reasons why an athlete may experience sudden discomfort is possibly due to their current loading exceeding the capacity of their tissues at the hip and knee.

2) Improve Knee and Hip Strength
The way we approach this in rehab is to train the surrounding muscles targeting the hip and knee. We load heavy movements such as squats, lunges, and glute work, as well as starting to load dynamically. Meaning, we work on strengthening into deep knee and hip bending at various speeds to challenge those areas. For runners who have issues related to downhill running and MUST withstand those types of loads, this is CRUCIAL for preventing pain in the ITB. Having a rehab professional to figure out what areas you need to target is important, because these are general guidelines are not specific to you. Find someone who will take time to listen to what your specific situation is and can tailor a program to your needs that involves loading and strength training for athletes.

3) Address Biomechanics
For runners dealing with ITB pain, manipulating different variables such as step rate and cadence can be beneficial for distributing forces away from the knee. Research has shown by increasing step rate by about 5%, we can decrease the total shock absorption at the knee by about 20%. Manipulating biomechanical variables can be a good way to allow the athlete to continue training while rehabbing the injury.
Hopefully this clears up some of the common misconception that you may have heard in the past. If you’re experiencing pain limiting you from living the active lifestyle you want, get in contact with us! We want to help you live an active fulfilling life pain free!

A Runners Guide to Achilles Tendinopathy

The Achilles tendon (AT) is a pretty cool tendon in our body that originates from our Soleus muscle (a giant workhorse) for running and connects with the two bellies of the Gastrocnemius (another HUGE giant workhorse) during running before inserting onto the calcaneus or heel bone. Our achilles tendon is the largest and strongest tendon in the human body as it has to withstand upwards of 12x body weight load during running!)

Given the demands placed on the AT, it’s not surprising that it’s commonly affects runners. This often manifests as a “tendinopathy,” which is an umbrella term used to describe pain and injury to the tendon typically when the current capacity of the tendon has been exceeded. Regarding tendinopathy, the tendon can progress or regress down the continuum based on the loads it is exposed to until at either ends of the spectrum we have a “rupture” or a “healthy tendon.” The most common phases we see people dealing with tendon pain are when they are in reactive , disrepair, and degeneration. With the tendon being in the reactive or disrepair phase, we can actually reverse it structurally back up the continuum towards a healthy normal tendon. However, when the tendon reaches degeneration phase or rupture, there is nothing physically we are able to do to change the actual structure of the tendon. But what we CAN do is improve the cross sectional area and collagen fibers of the SURROUNDING tendons which can ultimately improve overall tendon FUNCTION, allowing you to get back to the activities you want to be able to do pain free!

With achilles tendinopathy we have two big main types. We have mid insertional which is the main one that everyone thinks about right, right in the middle of the Achilles tendon, and we also have insertional achilles tendinopathy where we are dealing with it a bit lower where the tendon inserts on the calcaneal heel.

Because of the insertion site, compression is typically a lot more sensitive and painful in insertional achilles tendinopathy rather than mid insertional achilles tendinopathy. Compression at the achilles tendon typically occurs in end range dorsiflexion where we have the toes pointed upward. So common rehab movements in end range DF such as ankle DF stretching, as well as deficit heel raises, can actually flare up insertional achilles tendinopathy even more when you dose those in too early! So it’s super important to distinguish between the two types early on in order to know how to appropriately dose exercise and load the tendon in a meaningful manner.

When it comes to management of Achilles Tendinopathy we typically like to separate into 2 different phases. Phase 1: Calm Shit Down. Phase 2: Build Shit Back Up.

Phase 1: Calm Shit Down
· we typically want to temporarily remove stressors that aggravate and are sensitive (Typically this relates to plyometric energy storage/release movements such as jumping, hopping, running, uphill running, speed work etc.)
· manipulate different variables such as (mileage, speed, type of environment) to allow the athlete to continue training within tolerance in order to prevent deconditioning
· minimizing compression for insertional achilles tendinopathy (avoiding end range calf stretches) and maybe even putting in a heel lift to allow the heel to go into a bit of plantarflexion from neutral if it’s really aggravated.

Phase 2: Build Shit Back Up
Things such as PRP, shockwave therapy, corticosteroids, and NSAIDs all have been shown to be less effective than exercise. Tendons respond to load and so when looking to improve overall capacity of the tendon, we want to dose it with different exercise variations to the gastroc, soleus, and overall achilles complex. We can split up loading progressions into 4 different stages:
Stage 1 (Isometrics)
ex. Calf raises (hold)
Stage 2 (Isotonics - eccentrics, concentric, HSR (heavy slow resistance)
ex. Deficit Calf raises (isotonics)
Stage 3 (Energy Storage Exercises - plyometrics)
ex. Double Leg POGO hops
Stage 4 (Return to Sport)
All of these are phenomenal options in terms of finding the appropriate entry point of loading where we’re dosing enough to increase the strength of the tendon and not doing too much and overloading the tendon. Entry point of loading will vary based on where the tendon is on the continuum as well as level of sensitivity and other stressors as well.

Major Keys to Consider with Tendon Injuries
Treat the Donut - not the Hole! - Focus on improving tendon FUNCTION not structure!
Be Patient and Trust the Process! - Find a great physio who can help guide you through the process and be patient. Know that it can take up to 12 weeks for physiological adaptations and changes to occur!
Load the Tendon! - Tendon’s respond to load and in order to improve tendon capacity, we need to be loading the tendon >70% 1RM intensity to elicit appropriate adaptation.
Manipulate Different Variables to Continue Training! -Manipulate different factors such as training volume, frequency, and duration in order to continue to stay active and prevent de-conditioning!
Stay Positive and Count the Small Wins! - Managing and getting through tendinopathy injuries definitely is no easy task and it’s important to stay positive! Don’t let this one injury define who you are. Count the small wins and keep trucking along! You got this!

If you’re a runner dealing with achilles issues or heel pain, get in contact with us! We have helped hundreds of runners get back to running pain free and hit PRs in their races without any issues and we want to do the same for you!

What You Should Know Before You Purchase Your Next Running Shoe!

The purpose of this blog is to discuss how we came to the modern shoe today; vibrant colorways, cushion, fancy laces, and so on. I also want to discuss how the shoe industry has done a FANTASTIC job at confusing the consumers into spending money on shoes that they feel will “fix” their foot posture during running, and how doctors and shoe companies have intertwined pain and shoe wear in the mind of the consumer.
Often times, is SO common to feel overwhelmed, confused, and distracted by flashy colors and brands when you go in the running store. Of course we all love shoes that “look cool”, or I have heard many runners who match their shoe to their outfit. We can get sidetracked and end up picking a shoe that has too many bells and whistles, when really we just want something between our precious feet and the road. My goal of providing this information is for more people to have basic knowledge of why shoes are the way they are today, and what basic things you need to remember when shopping for shoes.

This is a more historical version and in-depth version of our PAIN FREE RUNNING GUIDE, that you can download HERE. 
From Clod Hoppers to Frog Feet: A Quick History

There is a beautiful side-by-side of what running shoes were in 1912 and what they have evolved into now in 21st century. You think that your feet take a beating now? We have slowly developed shoes to be softer and more cushioned, to the point where some people describe shoes as “running on clouds”.  
In the mid-70s podiatrists gathered and discussed why they thought runners had so many ankle, foot, and knee injuries. They collectively decided it HAD to be due to too much impact or pronation (2). They also decided to give shoe recommendations based on foot shape, and this continues today. The industry continued to not only be shaped by the conjecture of doctors but of the popularization of running shoe fashion, including the building of brands such as Adidas and Nike. 

As you can see, things such as non-science related like book publishings (loved Born to Run) greatly impacted the way shoes were being discussed and used in the general population. It turned out that as soon as Born to Run came out everyone wanted minimalist shoes, and did not properly transition from their previous cushion shoes (2). Not allowing your muscles and bones to gradually build up resilience to less cushion lead to injuries, where it is now commonly understood that if you transition types of shoes you must follow a transition. Unfortunately, non-evidence based publications like these led people to be more confused than they were before about what they really should be wearing, or how to transition into what they wanted to wear. 

Matching Cinderella’s flat foot to the glass slipper: does it prevent injury?
To this day, many individuals still correlate foot dysfunctions to footwear, and assume that with a specific foot shape they need a specific shoe. This partially has to do with the original podiatrists who believed that poor foot mechanics and foot posture were the root cause of injuries, and therefore shoes were made to accommodate those movements or prevent them from occurring at all. However, the research tends to point towards the opposite direction and that wearing a certain particular shoe has no relationship and correlation towards decreasing injuries.

There was a large study conducted with the U.S. Military where over 1,000 individuals were assessed for foot type according to these examples (3-5): 
If you have high arched feet? ——> You need a cushioned shoe,
If you have flat arches? ——> Your feet need some support with rigid insoles and a motion control shoe.
If you fit in neither of these categories and just have a deemed “medium” arch? ——> Try out a stability shoe.
Even though each individual was matched to their prescribed shoe based on what the industry understood at the time, it DID NOT predict injury risk and did not prevent injury regardless of gender or foot type (3-5). This reinforces the current understanding that to prevent pain and injury, a shoe is not going to be the band-aid to fix these problems. Adequate preparation, proper training, load management, and recovery are the keys to a successful running program. We have come to understand that pain and injury are much more complex than a simple shoe prescription. It is a matter a person’s training, life, beliefs, and so on.
While the latest technology, designs, and cool colorways may all seem alluring and “sexy”, the number one thing that reigns supreme in terms of finding the best running shoe will be COMFORT. Having a comfortable shoe will allow you to spend more time on your feet for longer, better runs. So experiment! Try out a range of shoes ranging anywhere from the high arch support cushioned Hokas to the minimalistic shoes! With this knowledge, I hope you have a bit more understand of what you should look for the next time you head to your favorite store to pick up a new pair of running shoes!

Nigg B, Baltich J, Hoerzer S, et al. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’. Br. J. Sports Med. 2015;49:1290-1294.

1. Davis IS. The re-emergence of the minimal running shoe. J Orthop Sports Phys Ther. 2014 Oct;44(10):775-84. doi: 10.2519/jospt.2014.5521.
2. Knapik JJ, , Brosch LC, , Venuto M, , et al.. Effect on injuries of assigning shoes based on foot shape in Air Force basic training. Am J Prev Med. 2010; 38: S197– S211. 
3. Knapik JJ, , Swedler DI, , Grier TL, , et al.. Injury reduction effectiveness of selecting running shoes based on plantar shape. J Strength Cond Res. 2009; 23: 685– 697.
4. Knapik JJ, , Trone DW, , Tchandja J, , Jones BH. and Injury-reduction effectiveness of prescribing running shoes on the basis of foot-arch height: summary of military investigations.

ACWR: A Better Way to Decrease Injuries Than the 10% Increase Running Rule?

Running is one of the most popular form of exercise around the world as it can provide a ton of health benefits and has a low barrier of entry to starting. Unfortunately, there are a ton of running related injuries (RRI) that affect both competitive and recreational runners each year, limiting them from performing at their best potential.

While running related injuries are often multi-factorial, one of the main reasons why athletes experience an injury is due to inefficient progression of running loads. The human body is extremely remarkable in terms of being able to adapt when provided with the right amount of stress. When a certain stress is applied to the human body, the body will respond by trying to adapt to the added stressor. If the stimulus is too low, the body won’t adapt, too high of the stimulus, and our tissues can’t adapt fast enough and possible injuries can occur. Just with any kind of sport or activity such as training for a marathon or an Olympic weightlifting meet, you need to have the right program and progression to provide your body with the “optimal” stimulus in order to achieve the best performance while minimizing injury risk.

One of the most popular running progressions is the “10% Rule” where it states that athletes looking to increase their weekly running workload mileage should only increase in increments of 10%. (ex. If you’re running 30miles total in 1 week, you should only run 3 more miles (33miles) the following week). Unfortunately, the 10% Rule is a very generalized form of progression and we see that athletes in a study by (Buist et. Al, 2008) who utilized the 10% rule, did no better than a unsupervised running program, which resulted in both groups having a 20% injury rate in novice runners.

A better way to manage running workloads would be look at an athlete’s Acute:Chronic Workload ratio as a means of assessing the athlete’s current and past training history, levels of fatigue, and their readiness and ability to progress. It allows us to measure an athlete’s current workload stress on the their body and compares it to the long term workload stress on the body to examine what they have previously done and what they are prepared to do. The acute workload can be measured as the amount of work the body has performed in the last 7 days and the chronic workload is the average amount of work the body has performed in the last 4 weeks. A recent systematic review in February 2020 (Maupin et. Al 2020) took a look at athletic workloads across multiple different sports and saw that an Acute:Chronic workload ratio (ACWR) between 0.8-1.3 was the best range to improve performance while maintaining a low injury risk while a ratio greater than 1.5 resulted in increased injury risk.

The good thing about utilizing ACWR is that it also allows us to factor in subjective fatigue to autoregulate training as this can allow us to account for external factors such as nutrition, life stressors and sleep) all of which can affect performance. This can be done by utilizing RPE (Rate of Perceived Exertion) into the ACWR formula. The level of difficulty or RPE (Rate of Perceived Exertion) is a scale from 0-10 where 0 is basically resting while 10 would be the hardest race they’ve ever ran. Athletes can basically take their most recent run and give it a RPE rating for their training that day.
For running, we can calculate the chronic workload as the average (miles or time ran) x (difficulty of the run) for each week over the last 4 weeks

For each week the weekly running loads would be calculated and the last months work would be averaged together to find the running loads
Ex.
Week 1: 1275
Week 2: 1400
Week 3: 1550
Week 4: 1350
Average Chronic Load: (1275 + 1400 + 1550 + 1350) / 4 = 1394
Week 5: 1600 (Acute Workload)
Acute:Chronic Workload Ratio:  1600: 1394 = 1.14

Athletes and coaches can utilize this as a rolling model to view and monitor workloads, as well as utilize it as a helpful insight into training load progressions and periodization. Obviously each athlete will vary differently based on their own individual adaptability, but for the regular runner just starting out, staying between the 0.8-1.3 range will be an ideal place to start. “Running too much” and “high training workloads” may not be a cause or problem of increased injury risk but rather HOW you get to those high training workloads may be the issue. How you increase your training and whether or not you’re maintaining a solid chronic workload will be bigger factors that help protect you from future injuries.
 
If you’re an athlete who has been experiencing long histories of running injuries, I highly encourage you to implement this into your training. This could be what changes that pattern!

What Is BFR (Blood Flow Restriction) Therapy?

BFR or Blood Flow Restriction is the application of a tourniquet system to a proximal arm/leg which is inflated to a specific pressure (80% of Limb Occlusion Pressure (LOP) in LE and 50% of LOP in UE) in order to reduce blood flow during exercise. By limiting blood flow and oxygen to the area, we can mimic the metabolic demands and environment, and reap the same strength/hypertrophy benefits as if we were training at a high intensity but without actually needing to utilize heavy resistance or weights.

History of BFR

• The 1970s: BFR was first initially discovered by Dr. Yoshiaki Sato in 1973 where he had sustained an ankle injury from a skiing accident that caused him to be in a cast for 6 weeks. Not wanting to lose muscle mass, he experimented with different belts and isometric exercises on himself. When the cast was removed, doctors were shocked to discover that his leg wasn’t atrophied or tender. Soon after he began experimenting on himself and other people with this method as a means to prevent muscle atrophy and improve muscle strength and hypertrophy.
• BFR In the USA: BFR initially started with the US military and NASA where they utilized BFR as a tool to preserve muscle mass in wounded soldiers to avoid amputation and to maintain muscle mass in astronauts affected by low gravity in space
• BFR Today: Today, BFR is a popular rehab and recovery tool utilized by a large variety of population ranging from professional athletes all the way to your older geriatric population

• The American College of Sports Medicine (ACSM) recommends that in order to make increases in muscle strength and size, you need to be lifting weights at a moderate – high intensity- specifically >70% of your 1 rep max (1RM)
• Unfortunately, a lot of times, people aren’t able to lift loads above 70% of their 1RM due to certain limiting factors whether it may be due to injury, pain, or post op surgery protocols. And often, you’ll actually see de-conditioning and even muscle atrophy due to the lack of activity and strength training at the appropriate intensity.

• This is where BFR comes in. By restricting blood flow and oxygen to a certain limb, we can create an anaerobic lactic environment that forces the body to recruit more muscle fibers (Type 2) which are typically reserved for more intense and strenuous activity seen when training at 70% of 1RM or higher.
• Studies have shown that BFR can improve release of Human Growth Hormone (HGH), Insulin-Like Growth Factor (IGF-1), and improve VO2 Max - all of which are important for improving strength and endurance during training.
• So by utilizing BFR, we are able to work out at a relatively low intensity and low load (usually 20-30% of your 1RM or even bodyweight), and still reap the same benefits of increasing strength and muscle hypertrophy as if you were lifting at 70% of your 1RM WHILE minimizing stress on tendons, ligaments, and joints!

• Athletes who are injured and want to increase their strength but are unable to exercise and weight train due to pain.
• Post surgical patients who have weight bearing and exercise precautions and want to increase strength and prevent muscle atrophy.
• “In-season” athletes who want to make increases in strength and hypertrophy without needing to recover from high intensity training affecting their in-game performance.

• Utilizing a Doppler ultrasound, Limb Occlusion Pressure (LOP) is measured in order to provide an accurate and appropriate safe restriction during exercise.
• Common areas to detect pulses to measure LOP utilizing Doppler Ultrasound include radial or brachial arteries for the upper extremities, and dorsal pedis or posterior tibialis arteries for the lower extremities.
• From there, the cuffs are inflated to 50% of the LOP for the upper extremities and 80% of LOP for the lower extremities.
• Current research suggests that the most common BFR Protocol is 75 repetitions over 4 sets (30/15/15/15) with a 30 second rest in-between.

Performance Enhancing Nutrition Series Part I: Tart Cherry

Tart cherries and tart cherry juice are an abundantly rich source of antioxidants and anti-inflammatory polyphenols. Because exercise causes oxidative stress, inflammation, and muscle damage it has been proposed that these compounds in tart cherries may help both strength and endurance athletes by reducing muscle damage, reducing pain levels, improving recovery, bolstering the immune system, and improving sleep.
Potential Benefits and/or Claims *see end for references
Lessen Muscle Damage
Reduce Pain
Improve Recovery
Improved Sleep Duration & Quality
Bolster Immune System

Dosage and Food Form 
The immediate allure of tart cherries, for me, is that they can be taken in whole food form – we don’t need them to be processed into a supplement. I firmly believe in turning to whole foods first. That is if the researched dose of the beneficial elements of a food can be healthfully obtained through the whole food. And, tart cherries can.
Dose: 50 tart cherries
Frequency: 1-2 times daily
Timing: varies depending on desired benefit.  Research on recovery often gives athletes tart cherries over an acute time period, centered around a competitive event. Typically around 4-5 day prior to and 2-3 days post event. 
Most researchers use the ‘equivalent of 50 tart cherries’ once or twice daily. Naturally, my nutrition nerd curiosity got the best of me and I wondered how the different forms of tart cherries stacked up- by nutrition, cost, and added ingredients. So, here it is:

Tart Cherry Product, Serving Size *Cup Equiv., Calories, Carbohydrates, Fiber Added, Ingredients, Price per serving
Cheribundi Regular 8 oz, 1, 130, 32, 0, Apple juice, $1.63
Cheribundi Light 10 oz, 1 & 1/4, 100, 26, 0, water, Reb A, $2.05
Cherry Bay Orchards, concentrate 4/5 oz,<2 Tbsp, 64,15, 0, $0.50
Dried Tart Cherries, sweetened 46 gm 1/3, 151, 37, 1.2, sugar, oil, $1.53
Dried Tart Cherries, unsweetened 44 gm 1/3, 141, 33, 3.3, $2.00
Tart Cherries, canned in water 151 gm, scant 1 cup, 96, 22, 3.2, water, $1.75
*equal to 50 tart cherries

Please note: the information in the table above is representative of the nutritional value and price of these products as provided by their customer service and sales in Jan 2018. There are many different brands of tart cherry products – this is a small sample of the brands which are easily accessible to athletes with transparent tart cherry concentration information. I purchased all these products – no compensation was provided for including.  

The information provided in the table above are things that, as a dietitian, I feel may weigh into someones choice of using one avenue of cherry consumption vs another. If you are unsure which is best for you and your training, or you’re wondering when you should eat/drink your cherries, contact me.
Concerns or Unknowns
There may be a time during training when we do not want to override our body’s stress response by providing exogenous antioxidant sources  – say during the build up phase of training, where we do not want to blunt the bodies natural physiological adaptations to training. However, more research is needed on this and it may be less of a concern when consuming a whole food product vs a mega dose antioxidant supplement.
Only one study has been conducted on non-land athletes, and it did not show a benefit to consuming tart cherries. This raises the question, are tart cherry compounds less beneficial to athletes who aren’t going through the wear and tear of a land athlete? Is there a differing oxidative stress load in aquatic athletes that may be responsible for the lack of benefit? Perhaps.
Long term benefits? Research hasn’t explored this in depth. It would be interested to see more studies on joint pain and tart cherry intake in athletes over a 3-4 month training period. There is some anecdotal ‘word on the street’ that professional and Olympics athletes are using tart cherries in this manor.
Final Thoughts 
There’s no doubt that the antioxidant and anti-inflammatory components of tart cherries are beneficial to our bodies. Current research shows promise that tart cherries could be an advantageous addition to an athletes diet in various ways. For many athletes, the allure is the proposed alternative of using tart cherries in place of NSAIDs.
With this being consumed in a whole food form, the potential benefits certainly outweigh the very minimal risk. And, when taken at the appropriate times during training, could certainly give a well trained athlete the edge they are looking for.
Research
Bowtell et al. Montmorency cherry juice reduces muscle damage caused by intensive exercise. Med Sci Sports Exerc. 2011;43(8):1544-1551.
Howatson G et al. Influence of tart cherry juice on indices of recovery following marathon running. Scand J Med Sci Sports. 2010;20(6):843-52.
Howatson G et al. Effect of tart cherry juice on melatonin levels and enhanced sleep quality. Eur J Nutr. 2012;51:909-916.
Kuehl et al. Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial. J Intern Soc Sports Nutr. 2010;7:17.
Bell et al. Montmorency cherries reduce the oxidative stress and inflammatory responses to repeated days high-intensity stochastic cycling. Nutrients. 2014;6:829-843.
Vitale KC. Hueglin A. Broad E. Tart cherry juice in athletes: a literature review and commentary. Curr Sports Med Rep. 2017 Jul/Aug;16(4):230-239.
Schumacher HR et al. Radomized double-blind crossover study of efficacy of a tart cherry juice blend in treatment of osteoarthritis (OA) of knee. Osteoarthritis & Cartilage. 2013;21:1035-1041.

Performance Enhancing Nutrition Series: Part II Collagen or Gelatin + Vitamin C

Collagen is the main structural protein that makes up connective tissues in the body.
Vitamin C functions as a co-factor in collagen synthesis. More commonly, people may be familiar with the deficiency of Vitamin C or scurvy – the disease that gave pirates their classical look of no teeth and missing limbs – but really the deficiency of vitamin C disrupted the synthesis of collagen and led to poor wound healing, bone loss, and much more.
Gelatin is made from the skin, tendons and ligaments of cows and pigs. Therefore, gelatin is essentially a derived protein from the breakdown of animal collagen. A study by JE Eastone from 1955 examined the amino acid profiles of different commercially available gelatin and animal collagen and found them to be ‘closely similar’ concluding ‘gelatin is representative of the main protein constituent of collageneous tissues in amino acid composition.’
You’re likely familiar with gelatin as a food product that makes gummy candy or gives Jello its signature jiggle. Hydrolyzed collagen protein supplements are further broken down to dissolve in water and not create a gel. Both gelatin and hydrolyzed collagen have been used in research studies to support the potential benefits and claims below.
Potential Benefits and/or Claims *see end for references
Increased collagen synthesis
Improve tendon function
Prevent injury
Speed healing post injury
Decreased joint pain
Increased cartilage thickness
 
Dosage and Food Form 
The easiest and more readily available source of gelatin is Knox gelatin, found at any grocery store. It is also the most cost effective ($0.23 – $0.60 per 7 gm servings, individual packets vs bulk on Amazon at the date of publishing). Remember, gelatin is made to form a gel – so when you mix this with a high vitamin C juice it will be slightly lumpy. Another option is a collagen hydrolysate, such as Vital Proteins. ($0.73 – $1.70 per 10 gm serving, individual vs bulk on their website at the date of publishing) Because of the further processing of this protein, it will mix with a high vitamin C juice. 
Dose: 5-15 gm gelatin + 50 mg Vitamin C (Or, 10 gm collagen hydrolysate + 50 mg Vitamin C) 
This would be approximately 1 heaping Tbsp (10 gm) or 1 pkt (7 gm) of Knox gelatin + 6-8 oz juice with vitamin C. 
Frequency: Best results are seen when taken before exercise targeting the injury site. Therefore, it doesn’t have to be daily but rather targeted to your training. (See Timing for more details.) Perhaps 3-5 times weekly.
Timing: This is best taken 30-60 minutes before a high intensity training of the specific injury site. (This could be something such as calisthenics targeting the injured tendon/ligament or an endurance training session.)  
Concerns or Unknowns
Much of the research on tendon/ligament response to collagen/gelatin + vitamin C comes from engineered ligaments (from human ACL cells) exposed to similar conditions your body would provide your tendons/ligaments with supplementation of collagen/gelatin + vitamin C. It’s incredibly hard for researchers to directly study an intact human tendon or ligament. This means we have to extrapolate the data and with this always comes some assumptions and uncertainties.
Final Thoughts
Does collagen/gelatin + vitamin C enhance performance for everyone? The verdict is still out on that one. But, if you have a history of a tendon or ligament injury or current injury to these tissues, the research certainly supports giving this a try. The healthier your soft tissues, the harder and more frequently you can train which will ultimately enhance performance.
Research
Eastone JE. The amino acid composition of mammalian collagen and gelatin. Biochem J. 1955 Dec;61(4):589-600.
Maughan RJ et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med 2018;52:439-455.
Shaw G. Lee-Barthel A. Ross M. Wang B. Baar K. Vitamin C- enriched gelatine supplementation before intermittent activity augments collagen synthesis. Am J Clin Nutr 2017 Jan;105(1):136-143.
Levine M. Violet PC. Breaking down, starting up: can a vitamin C-enriched gelatin supplement before exercise increase collagen synthesis? Am J Clin Nutr 2017;105:5-7.
Baar K. Minimizing injury and maximizing return to play: lessons from engineered ligaments. Sports Med 2017;47 (Suppl 1):S5-S11.

How-To: Master Your Hydration Plan

We all get salty crusty. Some with much more visible salty sweat rings than others.
Hydration is one of the most personalized elements in sports nutrition. There is no one-size-fits-all recommendation. It varies so dramatically from person to person and is very hard to predict without some cold, hard science. So let’s nerd it out –
Basics of Hydration & Sweat
Water is the largest constituent of the human body. It is essential to maintaining optimal physiological function and health. Our body is made up of 10-12 gallons of water. Water is a transporter of all the nutrients in our body. It eliminates waste and toxins. It lubricates our joints and organs. And thankfully for us athletes, it dissipates heat through sweat to help us regulate our body temperature during exercise.
The DRI (dietary reference intake) for water is 2.7 L for women and 3.7 L for men per day. This includes water from all beverages (except alcohol) and liquid in food. So, they estimate that 80% of your water comes from fluid, the rest from food. I’ll do the math for you – this is where the 8 cups for women and 10-12 cups for men per day originated. It’s important to note that these recommendations are based on the ‘median intake of generally healthy people.’ We athletes are certainly considered generally healthy but our sweat losses can greatly increase these needs.
We lose not only water but electrolytes in our sweat as a consequence of thermoregulation during exercise. In order to fully rehydrate, we need to replace not only the fluid lost but electrolytes as well.
There are two important elements to master your own personal hydration plan – knowing your sweat rate and sweat composition. 
Step One: Calculate Your Sweat Rate
A simple calculation can help you determine the amount of sweat you lose per hour during exercise.
Once you know how much you’re losing per hour, you can begin to calculate a plan for fluid on training runs, rehydration, and race day.
Your sweat rate may change related to weather (temperature and humidity), effort level, altitude, and physical condition status. It’s definitely worth the time to calculate your sweat rate for different conditions.
Step Two: Understand the Impact of Dehydration
For many athletes, it is a delicate balance between drinking and performance. Drink too much and you can risk stomach sloshing, GI upset, and hyponatremia (if you’re only drinking water.) Don’t drink enough and your performance suffers due to increased perceived exertion, higher heart rate, reduced blood volume, increased core temperature, decreased sweat rate and increased rate of muscle glycogen usage.
All of these things are truly a performance buzzkill. Relying on thirst isn’t a great idea because we don’t feel thirsty until we are already 1% dehydrated. And, at just 2% dehydrated our physical and mental performance begins to suffer.

Avoiding dehydration during a race is an important goal. But don’t forget about staying hydrated on a daily basis during and between training sessions. In a busy life filled with intense training sessions, it’s easy to overlook adequate hydration and over time dehydration can really sneak up on you and you’ll see your performance slowly start to decline.
 
Step Three: Perhaps You Need an Analysis of Your Sweat Composition
Many factors influence the electrolyte concentration in our sweat. As fitness improves, so should our electrolyte retention. In other words, an unfit person will usually lose more electrolytes than a very fit person. Another factor is heat acclimatization. If you trained all winter long in the cold, and race day was an unseasonably warm day, you could expect to lose more electrolytes in your sweat. Size may matter, as larger athletes tend to sweat more. However, there is also a large genetic component to sweat composition too.
The variability of sodium lost in sweat is huge. It can range from negligible to more than your daily requirement of sodium in just one hour. It’s not uncommon for endurance athletes to lose 3-8 grams of sodium in a 3 hour race. That’s 3-5 times your daily requirement of sodium or 1 1/2 to 4 tsp of salt.
If you are continually depleting your sodium stores throughout your training and not adequately replacing these losses, performance will suffer.
*1 L of sweat = roughly 2# sweat loss 

Several companies have been offering sweat composition testing at the elite and team level for years. Championship collegiate football teams routinely analyze their players sweat composition, conduct daily weigh-ins & weigh-outs, and develop detailed hydration plans. Gatorade Sports Science Institute has conducted series of sweat composition tests on elite endurance athletes to maximize athletic success and achievements. Now, this analysis is available on an individual level – mailed right to your house – for us all to fine tune our training.
After much research, I decided to contact Levelen, a leader in sweat testing for all athletes. My results and takeaways can be seen below. Please note: I was given a discount for my sweat testing but I was not paid for mentioning them. And, all opinions are solely my own. If you are interested in completing a sweat test, let me know. I have a discount code I can share with you. Again, no kickbacks to me. Just sharing the love!

Step Four: Nail Your Rehydration & Recovery
For every pound you lose, you need to drink 20 oz of fluid to fully replace this. Each pound lost represents 16 oz of fluid, however we need a little extra to rehydrate. It’s not a perfect system. Need to rehydrate more quickly between training sessions? Up that to 24 oz per pound lost.
Sodium is needed to adequately rehydrate. This can come from a sports drink with sodium or high sodium foods plus water. Add some carbohydrates into this mix to maximize your rehydration even further. Remember: this can be achieved through a combination of fluids and foods that works best for you.
Contact me anytime for help, advice, or suggestions to nail your hydration plan 24/7.
Who May Benefit from a Sweat Test

1. Heavy sweaters – especially those who participate in triathlons, marathon and ultramarathons, football, cycling, basketball, rugby, tennis, or other sports with padding in the heat.
2. Salty sweaters – you know who you are. As the sweat dries, you’re left with salt rings on your body and clothing.
3. Endurance athletes looking to individualize and optimize rehydration between training sessions and to perfect race day hydration.
4. Athletes experiencing muscle cramps. Muscle cramps are a complex phenomenon but the first culprit to rule out is a hydration component.
5. Those following a low sodium diet for health reasons. If you are following a low sodium diet, say 1500-2000 mg per day, and avoiding extra salt while training – you can see that you will deplete your sodium tank very quickly.

1. I am not nearly as ‘salty’ of a sweater as I thought. I am actually quite ‘average.’ I lose 950 mg of sodium per hour of running. Average losses for athletes is around 1,000 mg per hour. Another way to look at this is a 1/2 tsp salt an hour. Not a big deal for an hour of exercise, but if you’re looking at a 2 or 3 hour run or race – this adds up and absolutely needs to be accounted for in your fluid/food during races and training.
2. I lose significantly more potassium than average – 265 mg per hour of running and the average is 50 mg. But, this is still only a 1/4 of the amount of sodium I lose per hour (950 mg.) To put this into reference, half a large banana contains the amount of potassium I lose per hour. Other good sources of potassium are apricots, coconut water, melon, dates, potatoes, beets, and beans.  Fun Fact: the Institute of Medicine recommends 4700 mg potassium daily. Most American’s barely reach half of this recommendation daily. 
3. The weather (humidity and temperature) did not alter my sweat composition or rate. (I did two sweat tests one in hot and humid conditions and another in cool and drier conditions.) In fact, I lost slightly fewer electrolytes during the warmer and more humid weather. Riddle me that?! I feel confident knowing my hydration plan can hang tight regardless of the weather. I appear to lose about a liter of fluid per hour of running. 
4. After 80 minutes of exercise, my body will reach the 2% dehydration threshold where performance tanks. My current personal ‘rule’ is carry fluids for runs over an hour – I’ll stick to this. It’s easier to rehydrate after a run when you’re not totally in the hydration hole.
5. My husband is indeed a chemistry master. He converted mmol to mg of Potassium for me. Because my brain doesn’t comprehend mmol and DRI’s of nutrients – or really chemistry, anymore, for that matter. 
6. If you’re interested in seeing what your sweat ‘looks’ like, contact me and I’ll share a discount code and help you interpret the information into your training, if you want of course! Again, I don’t get any kickbacks from this – I’m just ruthlessly passionate about helping others perform at their finest through nutrition and hydration. Or a huge nerd who likes to see other peoples sweat composition – you decide if that’s creepy or cool! Kidding. 

What is Sport Psychology or Mental Performance?

Sport psychology is the science of training people to think more effectively within the context of sport and life. Mental Performance Coaches (AASP-Certified Mental Performance Consultants) are specifically trained to help people improve performance in sport and life. The following are some examples of areas athletes, coaches and people in general can work on to improve performance and as a person:

• Mental preparation for competition
• Focus
• Creating an optimal training environment
• Excelling under pressure
• Effective self-talk
• Resilience
• Concentration
• Quality Practice (improved quality of training)
• Visualization (Imagery)
• Confidence
• Mental Recovery
• General life stress and well-being
• Coach-athlete relationships
• Communication (coach and training group)
• Mental training for injury rehabilitation
• Critical transitions in sport career
• Mental aspects of the business side of pro sport

RAMP UP YOUR FOOT CONTROL TO BRING DOWN YOUR SHIN PAIN

If you have been dealing with aches and pains on the inside of your shin, it’s time to stop chasing your symptoms and fix the cause. “Shin splints” is the lay term used to describe what we in the medical community call “posterior tibial stress syndrome.” Let’s decode this term.
Muscles work by pulling two parts together. One lever is connected to another lever at a pivot point. During a bicep curl, your bicep contracts concentrically to pull your forearm up to your shoulder. A concentric contraction means the working muscle is shortening. When muscles work eccentrically, they move the levers by lengthening. An example of this is the “negative” phase of a lift, like when you lower the weight very slowly in that same bicep curl. Your bicep is working hard to lower the weight in a controlled manner. Eccentric control is actually very stressful to muscles. If you are like most runners, you might not be interested in bulking up your biceps, but you need to understand eccentric muscle contraction to solve your shin splint problem.
When the foot makes contact with the ground, it’s the job of the tibialis posterior muscle to work eccentrically to slow the foot as it twists down to the ground (pronation). In the case of the bicep curl, it’s easy to see how your rigid upper arm and your rigid forearm pivot on each other at your elbow. But the foot and ankle are more complex levers. The tibialis posterior attaches to your rigid shin (tibia) on one side, but on the other side there is not just one bone, but 26 individual bones that make up your foot. If that set of bones is well controlled, the tibialis posterior can work eccentrically to smoothly lower your foot to the ground. But if you show up with poor foot coordination and control, one end of the lever (your foot) is very unstable and likely to collapse. This compromises the tibialis posterior and its tendon. Muscles and tendons don’t like to be in lengthened positions where they are under more strain, become weaker, and can’t generate the eccentric control to guide your foot safely down to the floor. So your shin hurts.
What’s the Fix?
In this all-too-common scenario, the posterior tibialis is the victim, not the cause of the problem. It’s being asked to do more than it can handle, and more than it ever should. The poorly controlled foot is to blame. That bag of bones needs to become a stable platform. Foot control is 100 percent dependent on your forefoot control, specifically the big toe. With a stable big toe, your forefoot is stabilized, which creates a stable platform for your rearfoot, which means your tibialis posterior can stop trying to do the work of other muscles. Simply put, if you want to unload the muscles in your shins, you need to improve the control and coordination in your feet. To learn more about this and other problems that plague runners, please check out our founder’s book Running Rewired. But if you want to start improving your foot control now, MOBO is the tool to bring your foot up to speed and build a strong and stable foot. Get yours, hit the exercises tab above, and get to work on a better you.

Check out more info on my websites https://anathletesbody.com/ and https://www.moboboard.com/

WANT BETTER PERFORMANCE? BUILD BETTER FEET.

I know it can be a tough sell to tell athletes that they need to add yet another exercise to their weekly training plan. But remember we aren’t training just the knee and above - we need to train the entire athlete —> and that includes the foot as well! But I get it, most athletes don’t get excited about just training to minimize injury, they want to see results. We believe in pushing the needle in every way possible. And do so with our athletes. And yes, we have clinical proof, outcomes proof, and yes research proof. Let’s summarize the references below: Attempts to strengthen the feet ARE successful, and more importantly that improving foot strength results in an INCREASE in performance.
So when you are talking to your athletes and patients: improving intrinsic foot control isn’t just “something else to do.” - its part of optimal preparation.
Want this said simply? Here’s a great summary statement from the Suloska paper referenced below: “Exercises strengthening short foot muscles may improve energy transfer through body segments and increase strength and values of generated power. They should be included as a part of daily training programme of runners.”
Leave no stone unturned. That’s our moto with our athletes. And while we hope you use MOBO as part of this journey with your patients and athletes, we really hope that whatever tools you use, you address the whole body for better outcomes!

Check out more info on my websites https://anathletesbody.com/ and https://www.moboboard.com/
 

1. GoldmannJP et. al.  The potential of toe flexor muscles to enhance performance. J Sports Sci. 2013;31(4):424-33. 
2. Brüggemann, et. Al. Effect of increased mechanical stimuli on foot muscles functional capacity, ISB XXthCongress - ASB 29th Annual Meeting, 2005.
3. Suloska, et, al. The Influence of Plantar Short Foot Muscle Exercises on the Lower Extremity Muscle Strength and Power in Proximal Segments of the Kinematic Chain in Long-Distance Runners. BioMed Research Int2019, Article ID 6947273

Static & Dynamic Stretching

When it comes to the use of stretching there seems to be more opinions and confusion than there are straight answers.  You may be asking yourself: Do I stretch before runs? Do I stretch after runs? Is stretching detrimental to my running performance?  

These are good questions to ask.  The reason for the confusion is because the results of the research is not clear.  However, part of the confusion can be cleared up by simply defining our terms.  When we talk about stretching we need to make sure we are talking about the same thing.  The timing of the stretching needs to be considered.  There is pre-activity stretching, routine or regular stretching, and post activity stretching.

Pre-activity stretching is stretching done immediately prior to an athletic event.  Routine stretching is stretching that is performed as a regular part of your fitness routine.  It is a dedicated time 3 to 5 days per week that emphasizes joint range of motion and muscle flexibility in an effort to maximize your body’s mobility.  Post activity stretching is a type of routine stretching that is performed regularly shortly after an athletic event to take advantage of the increased tissue temperature of the muscles to maximize their extensibility.

There are also different types of stretching.  There are three basic types of stretching; static stretching, dynamic stretching, and ballistic stretching.

Static stretching is the traditional type of stretching.  It is slow and controlled passive movement of a muscle beyond the tissues normal range of motion that is held for a period of time, usually between 15 and 60 seconds

Dynamic stretching is an active stretch in which the person actively uses a muscle to bring the opposite muscle to the available end range of motion to create a dynamic stretch.  For example, a dynamic leg swing uses the hip flexors to elevate the leg to dynamically stretch the hamstrings

Ballistic stretching is an active stretching technique that uses a bouncing motion to take a muscle beyonds its normal end range of motion to increase flexibility.  A common example of this is bouncing toe touches.

Now that we have defined our terms it will be easier to make sense of all of the different recommendations regarding stretching.  

Pre-activity stretching has been shown in some studies to actually decrease strength and power with the athletic performance that immediately follows the stretching.  It has also not been shown to decrease risk of injury.  As a result, we do not recommend pre-activity stretching prior to doing a run.  However, this does not mean you should go out and run without any warm up routine.  We strongly recommend a good dynamic warm up prior to running of 10-15 minutes prior to initiating your run.

In contrast to pre-activity stretching, regular stretching may improve athletic performance.  In addition it may also decrease your risk of injury.  

Static stretching has been shown to be an effective and safe way to improve muscle flexibility and it is just as effective as dynamic and ballistic stretching.  However, there is increased risk of injury doing ballistic stretching.  Consequently we recommend doing static or dynamic stretching as opposed to ballistic stretching for your stretching routine. 

- Mark Baughman PT, DPT, OCS, ATC 
  Coltman & Baughman Physical Therapy 

The Off-Season: What you SHOULD be doing.

Guest Speakers:
Christopher Lee - Athletic Performance Director @ Tinman Elite
Maddie Alm - Registered Dietician & Pro Runner
Kurt Roeser - Physical Therapist & Pro Runner

We take you through some key points of success and an athlete Q&A

Kinesis Video Library

ALL VIDEO LINKS HERE