Resource Library

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.

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.

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

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?

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!

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! 👣

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!

Leg Strength Circuit - Plyos

Leg strength being one of the baseline essential factors for healthy running, this circuit helps runners develop strength in functional movement as well as movement precision and coordination. By focusing on single leg motion, runners can expect to develop stability and balance as well.

We recommend these types of circuits be implemented after initial foundations have already been established. For a more initial routine, see the stationary leg strength routine.

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!

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!

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! 👣

How to Run Longer

Originally posted on atozrunning.com
By Zach Ripley, running coach and co-founder of AtoZrunning

Every runner wonders about how to run longer, whether in pursuit of longer races like marathons, ultra marathons, and beyond, or in pursuit of increased training potential. And we all tend to qualify the question. How to run longer without getting injured. How to run longer in the heat. How to run longer in workouts. You get it!
You know from our podcast or other articles that we like to try to simplify these kinds of things, and this question is no exception. But before we share the two word answer to this question, let me briefly share what we’re trying to do here.
This article is merely the first in a series we will be publishing on How to Run. The ultimate goal of the series is to establish how to run better (also the title of the final installment), and to get there, we plan to focus on the most basic aspects: running longer and running faster. More specifically, running longer and running faster effectively.

The two-word answer to how to run longer
Run easier.
As far as we can tell, every authoritative source on running agrees on this point. So it’s a good answer. But it’s also not very well followed.
Have you ever set out for a run to find in the final third or so that you don’t have quite the energy to finish what you started (or perhaps that you do, but you’re wondering if you’re going to pay for it later)?
We all have. Even so, we find ourselves regularly falling into this trap. 
Here’s the first problem: we think things to ourselves like “8:30 is my easy pace, and since I do that for my easy 5 mile runs, I should do that for my easy 10 mile runs.” That may not be a conscious thought, but it is a common one. And falls apart under the weight of reality. We don’t run the same pace for a 10k and a half marathon race, so why would we run the same pace for an easy 6 or an easy 13 miles?
We wouldn’t. Not if the intended training stimulus is similar.

How much easier?
How much easier, then, is the first side of this coin, and while a whole lot of smart number crunchers have come up with clever ways of explaining this with heart rate and pace estimators, etc., such metrics are handicaps to the more essential need. We simply need to teach ourselves to run easy enough to finish the effort in the desired state. 
If I’m trying to get through an easy run, I need to finish feeling like I’ve got plenty more to give and am not doubled over. If I’m trying to get through a strong effort or a race, I need to be able to run as strong in the last 25% as I could have run in the first 25%.
One simple guiding principle makes all the difference here. When in doubt, ease up. From a purely pragmatic standpoint, almost nothing is lost in training adaptations by going a little bit slower on a run, be it an easy effort or something harder. Conversely, much is lost by overdoing an effort, especially a long effort, especially when done repeatedly over time.
Always remember that progress must be coaxed, courted even, but never coerced.

How much longer?
In order to know how much easier to run, though, we also must know how much longer to run. These two are answered largely at the same time, but there’s at least some sound wisdom we can apply that does not require trial and error.

• Increase incrementally
• Master one step at a time
• Change one thing at a time

1. System development (let’s call this energy, respiratory, and cardiovascular)
2. Neuromuscular development
3. Musculoskeletal development

Leg Strength Workout for Runners

Originally published on atozrunning.com
By Zach Ripley, running coach and co-founder of AtoZrunning

Every runner needs a good leg strength workout (or two or three). While running is itself providing the vast majority of strengthening a runner might need, most training does not address everything. How is your coordination and stability? When you stand on one leg, do you hold steady or wobble a little? How about when you do a standing lunge? What we find is that a targeted functional movement leg strength workout improves both running mechanics (and therefore economy) and perceived effort. 
Answer then, these simple questions: do you want to run better? Do you want to feel better while you run? Then listen up.

The Goal of an Effective Leg Strength Workout
For runners, the ideal leg strength workout fulfills two simple goals:

1. It strengthens the functional movement of the target muscle groups.
2. It leverages proper mechanical and postural elements of good running.

• Stand on one leg, arms in a relaxed running position.
• Squat down on one leg, moving the other behind with bent knee (running posture). Arms should follow opposite legs.
• Rise back to neutral, remaining on one leg the entire time (for all reps).

• Stand relaxed on both legs, feet parallel.
• With hands behind head or on hips, bend at the waist until about parallel to the ground.
• Keep back and legs straight the entire time.
• Return slowly to neutral and repeat.
• Try to keep everything still except your waist (avoid the temptation to push hips back while you bend).

• Stand relaxed on both legs, feet parallel, arms straight out in front of you.
• Squat slowly down past 90 degrees, then slowly return to neutral.
• Be sure to bend at the hips, pushing hips back as you squat and keep back straight.

• Stand on one leg, hands on hips. Be sure back is straight, chest up, and shoulders back.
• Extend the opposite leg out, keeping foot parallel (do not rotate hip at all) and knee straight.
• Return slowly to neutral, remaining on one leg the entire time.
• Extension should not be uncomfortable or cause compression in the side in order to achieve.

• Stand on one leg, arms straight out in front of you.
• Hold the opposite leg out in front as well, knee straight (it does not need to be fully extended but rather enough in front of you to stay off the ground).
• Squat down slowly, keeping back straight, extended leg straight, and arms in front of you.
• Be sure to bend at the hip.
• Return slowly to neutral.

• (Similar to single leg deadlift)
• Stand on one leg, arms relaxed at your side.
• Bend forward while bringing your leg out behind. Keep both your back and your extended leg straight.
• Swing arms straight out above head as you extend.
• Return slowly to neutral.

• Stand on one leg and spring upward, driving the opposite knee and moving arms opposite legs.
• Keep back straight and head upright.
• Land on the same foot, touching the ground with your opposite arm, then spring back up, driving the opposite knee all the way.

• Step forward with one foot.
• Drive the other foot laterally to the opposite side.
• Lunging to the side, touch the ground with your opposite arm.
• Return to neutral then repeat to the opposite side.

• Stand neutral with feet parallel, arms straight forward.
• Squat slowly down, pushing hips back and keeping back straight.
• Spring upward on flat feet. (Do not jump off the balls of your feet.)
• Keep back straight, arms extended, and eyes forward.
• Land on flat feet.
• Squat and launch again.

• Stand relaxed on one leg, the other knee raised to hip level, arms in running position.
• Hop upward and forward, flexing at the ankle, not the knee.
• Propel off toes.
• Land on the balls of the same foot and continue bouncing.

• Stand relaxed on both legs, arms in running position.
• Hop upward and forward, flexing at the ankle, not the knee.
• Propel off toes.
• Land on the balls of the feet and continue bouncing.

• Begin in a neutral position, arms in running position.
• Jump to a standard forward lunge position, extending one foot forward to land with knee at 90 degrees and the other back to land on toe with knee at 90 degrees.
• Keep arms in a running position opposite legs.
• Jump up and switch legs while in the air, landing in the opposite lunge position.

The Runner's Guide to Pain and Injury

Embracing Pain and Injury
I was just as distressed as you are about to be when I read the 2010 study from Current Sports Medicine Reports that indicated “40%-50% of runners experience injury yearly.” We already know that pain and injury are common, but numbers like that make it sting.
If we’re counting any small strain or some such as an injury, perhaps it’s not a stretch (the study indicated anything that necessitated any interruption in training). What such news ought to be, though, is a call to action. 
If we run, we know these two things with certainty: pain and injury are inevitable, and despite all, the times between make it worthwhile. This examination will simply better equip us to deal with the pain when it strikes in a manner that decreases the disruption to our training.

Understanding Pain
In college, I used to be known for gingerly approaching my coach before practice to announce, “Hey boss, when I do this thing and move in this very particular way, this other thing hurts in this very precise spot.” Any guesses how said coach most often responded? 
Don’t do that thing. 
He was on point for calling out my absurdity. Unfortunately, this also seems to be the most common reaction from general doctors when approached by a runner with a running pain. Stop running for a bit, and it will stop hurting. Right?
Pain is more complex than that, though, and warrants some amount of reflection. We will present in this guide our basic approach to responding to pain, and in order to do that, we need to clarify what we mean by pain.
We are all familiar with such terms as soreness, tightness, aching, burning, stinging, and the like. Let’s apply a simple caveat here: pain is the body’s signal that something is amiss. That signal always means something. That doesn’t always mean it is an especially notable or significant something, but as runners, our first priority in dealing with pain is understanding to what degree notable intervention is needed. 
When considering whether a pain is notable and worthy of significant intervention, apply these parameters:

• Has it been hurting for 2-3 days in a row?
• Is it acute and asymmetrical (hurts on one leg but not the other)?
• Does it progressively worsen during activity?
• Does it hurt even outside of activity (sitting, standing, walking, sleeping, etc.)?

• Nutrition, hydration, and sleep all contribute to how resilient our bodies are as well as how quickly and effectively they recover. Imbalance or shortcomings in these areas are sure to increase risk.
• Unimpeded movement is another basic necessity for the body, so things like simple regular myofascial release techniques go a long way (runners love their foam rollers, but things like graston technique and other more precise methods are often even more effective).
• Supple and pliant tissues tend to respond to exertion better, so consider something as brief as a gentle massage with an emollient to a tight area before activity.

1. seeing a medical professional (if not already), 
2. seeking diagnosis for the injury (something notable is wrong and needs to be clearly established if possible) by pushing for things like scans or specialist visits, and 
3. expecting a period of downtime and cross training.

1. Diagnose the issue and establish a plan for addressing the cause.
2. If possible, seek an alternative training option (cross training) that in no way risks the rehabilitation process but allows for aerobic activity of some sort.
3. Focus on rebuilding strength and stability.
4. When pain-free running is possible, very gradually increase to a full training load of easy jogging.
5. When a full training load of jogging is possible, revisit training goals and plans and resume regular training.

Should I get a Professional Running Analysis?

Why get a Running Analysis?

The primary reasons to get a biomechanical running analysis boil down to:
1. Performance improvement – run faster for longer
2. Reduce running injuries – by attaining a more efficient gait

While running has numerous health benefits, it is also associated with a high rate of injury. In a 12-month period, over 60% of runners may experience a running injury which will put them out for a period of time. And quite ironically, the weakest part of a runner’s body is often their gluts, legs and feet!  

How about a Running Shoe Store Analysis?

In theory, you could have your running analysis at any of several commercial running shoe stores. While we're sure the stores are well intentioned, a professional running analysis or gait analysis offers the full 360 view of your running ability versus a surface level look. Think of it like choosing to see a dental hygenist for your oral care but never seeing a dentist to know where your teeth truly stand. An over simplfied evaluation can cost you by leading to further unintended injury. A 2011 study found that the practice of assigning runners shoes based on their pronation is “overly simplistic and potentially injurious.”  

A detailed, individualized analysis of your body in motion while running can prevent injuries, help your injury, and provide invaluable self knowledge. 
Professional gait analysis, like that used at Alpine Fit Physical Therapy and Nutrition, is both evidence-based and holistic. A gait analysis can also help patients who suffer from the lower extremity conditions such as knee pain, hip pain and ankle pain.

The key to improving running is smarter movement. 

Your running gait, comprised of three phases, is the way your foot strikes and leaves the floor with each stride.
The three phases of running are the loading phase, propulsion phase, and recovery phase. Each of these phases are cyclical and because of that are inter-dependent with inefficiency in one leading to inneficiency in the subsquent phase and on and on for as many miles as you run.

Running is nothing but a series of single leg hops. These hops result in the transfer of energy from your body to the ground allowing for forward progression. As a runner your pace is determined by the amount of energy transferred. When biomechanically efficient, the body moves from one point to another expending the minimal amount of energy.

When running, the primary focus should be on how to become more biomechanically efficient which will naturally result in faster times if desired. But, most importantly, this efficiency creates a foundation of improved motor programs that support training without interruptions due to injury. 

Today’s Running Analysis is Holistic

Not too long ago, therapists looked for the cause of injury almost exclusively in foot motion, especially pronation (the natural motion of the foot when landing).  And while pronation is still an important part of running analysis, we know that much more is involved. 

We believe that running injuries are created “from the top down.” This means that hip and pelvic motion, as well as whole body position can be as important as the mechanics of the foot and ankle themselves. It is a whole body analysis which includes looking at your biomechanics, strength, and mobility as well as your running goals, diet, sleep patterns, and how you train. 

Here are some key points to consider when looking at your own gait:

• By improving your Standing Posture=>Walking Posture=>Running Posture
• Are you standing with your weight evenly distributed throughout your feet?
• Do you know what your static posture is and are you able to correct it if necessary?
• Can you tell which part of the foot you're primarily hitting the ground with? Heel or Mid-foot?       
• Are you having consistent pain? If poor biomechanics and improper loading may be the cause. 
• Interested to know more? Check out our Alpine Fit's Biomechanical Running Analysis. 

Cross Training Option for Runners

Are you a runner? Do you need to find another form of exercise to cross train?  Would you like to learn about dance as a form of cross training?  If you answered yes to any of these questions, then this blog is for you.  Below are five reasons why dance is a great form of cross training for dancers.  
 

1. Dance works the muscles differently

2. Improve your balance

3. Improve your flexibility

4. Build foot strength

5. Interval training

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

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

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.

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.

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!

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 👍👍👍

Stationary Leg Strength Routine

AtoZrunning helps runners thrive by providing information, inspiration, and community around the sport of running. From coaching services to podcasts and articles, runners can find content created by runners for runners.

In this video, we demonstrate a simple functional movement routine to build leg strength.

Cool Down Routine for Runners

Post-run routines can help with neuromuscular wiring and general strength and mobility. This routine is intended to support both. To accomplish this goal, always seek to perform each movement deliberately and slowly. Control is key.

For more, visit atozrunning.com

50+ Ways to Fix Toast

The next best thing since sliced bread was toasting those carbohydrate-rich slabs of goodness. 
This slab of goodness has rescued my morning re-fuel a time or two. If you’re like me, you’re tired because life is busy and you need to get breakfast in your belly ASAP. Make the most of the slice of toast and get some good nutrition to help build towards recovery.
If that wasn’t awesome enough, fixing them with a variety of delectable toppings. Toast can be the backbone to build solid morning nutrition. With little effort, your toast can become a rather fancy morning meal.

The Classic Toast
I get it. Sometimes all you want is the basic toast with butter. What can you use instead of butter? Let’s say you are out and dry toast is just sad. 
Substitutions for butter:

• Olive oil 
• Coconut oil 
• Ghee

• Chia seeds
• Crushed nuts
• Flax seed
• Protein Powder

• Cinnamon
• Pumpkin spice
• Nutmeg
• Blueberries
• Blackberries
• Raspberries
• Strawberries
• (most berries, you get the picture)
• Chia seeds
• Crushes nuts
• Flax seed
• Protein powder

• Eggs
• Cheese
• Tomato
• Spinach
• Garlic salt
• Raw or cooked peppers
• Cheese

• Nutella
• Peanut Butter
• Butter
• Ghee

• Chocolate chips
• Mini marshmallows
• Chia seeds
• Shaved nuts
• Flax seeds
• Protein powder

• Cinnamon (depending on flavor of yogurt)
• Fresh fruit
• Honey
• Chia seeds
• Protein Powder

• Everything bagel seasoning
• Tomatoes and balsamic
• Egg
• Feta cheese
• Avocado
• Cheddar cheese
• Veggies

21 Reasons to Run

Whether it’s a mountain run with the pup, running with friends, or a solo trail run there are many reasons to be thankful to get out on a run.
But beyond the obvious joy of running, there are 21 additional health reasons to consider if you're ever needing some additional motivation to lace up your running shoes. Here are 21 benefits to running:

1. Improves digestion
2. Lowers incidents of breast and colon cancer
3. Increases energy levels and endurance
4. Improves mood and cognition
5. Counters diabetes
6. Decreases stress
7. Improves muscle strength
8. Improves circulation
9. Improves self-esteem
10. Improves lipid profiles
11. Delays Alzheimer & Parkinson’s disease
12. Improves function in heart failure
13. Limits obesity
14. Improves fertility
15. Prevents hypertension
16. Improves sleep
17. Lessens risk and severity of strokes
18. Improves the health of offspring
19. Maintains bone density and decreases osteoporosis risk
20. Maintains joint ability
21. Strengthens immune system

Step by Step Nutrition Guide for Skiing & Snowboarding

Confused about how to fuel before, during, and after a day on the mountain? 

I've got you covered. This step by step nutrition guide was designed specifically for skiers and snowboarders. It covers what you should eat and why, plus get my favorite meal & pocket snack ideas to get you started (recipes included!) 

Get your free guide here.

Step by Step Nutrition Guide for Mountain Biking

Confused about how to fuel before, during, and after a ride? 

I've got you covered. This step by step nutrition guide was designed specifically for mountain bikers. It covers what you should eat and why, plus get my favorite meal & pocket snack ideas to get you started (recipes included!) 

Get your free guide here.

Mindfulness For Runners

When it comes to both taking care of the brain and training it for enhanced performance, there’s no better tool than mindfulness. A runner who regularly practices mindfulness can experience less stress, stay engaged with their training plan, manage emotions during races, and more easily recover between workouts and events. Mindfulness supports runners in the short and long term and can have impacts far beyond the trail.

WHAT IS MINDFULNESS?
According to Jon Kabat-Zinn, mindfulness is “awareness that arises through paying attention, on purpose, in the present moment.”  Mindfulness is an attitude, state of awareness, or way of being that comes from mindful practices. Mindfulness can be practiced anytime, anywhere, by intentionally shifting our focus to the present moment.  
Mindfulness meditation is a formal mindfulness practice that helps develop a mindful attitude and cultivate present moment awareness. It is often what comes to mind when people think of mindfulness.  Mindfulness meditation comes in many forms, not all which require stillness or sitting. The most compelling research on the physiological impacts and brain changes from mindfulness come from studies where participants engaged in formalized mindfulness meditation practice.

WHAT DOES MINDFULNESS HAVE TO DO WITH RUNNING?
Cultivating an attitude of mindfulness through intentional and consistent practice—especially the practice of mindfulness meditation—can have positive impacts on a runner both physiologically and psychologically.
Mindfulness teaches runners how to communicate with and regulate their bodies. With consistent practice, runners will learn to recognize when their sympathetic nervous system (fight/flight response) is in play and respond more efficiently when it is. Regular mindfulness practice produces structural changes in the brain that enhance communication between the prefrontal cortex (thinking part of the brain) and the amygdala (alarm center of the brain).   These changes help individuals shift from reacting to potential threats to responding to potential threats--- a helpful skill to have in the middle of a race.
As runners increase their mind/body connection, they can more easily notice subtle changes in tension or stress that allows them to intervene earlier, decreasing the likelihood of burnout or injury. Mindfulness practitioners may be more capable of noticing the impacts different fuels have on their bodies or have more insight into how they are responding to the stressors of training. As runners use meditation, they can learn more about themselves and apply that knowledge to their training and racing.
Mindfulness decreases stress. By engaging with mindfulness we tell our body that we are safe which activates a relaxation response and results in a lower heart rate, relaxed muscles, and lower blood pressure. As a result, we feel an immediate decrease in stress. At the same time, awareness gained from mindfulness can provide a sense of clarity or perspective that increases a sense of control over a situation, alleviating stress.
Furthermore, and perhaps more excitingly, consistent mindfulness practice decreases the activity in the amygdala and shrinks the amygdala itself—both leading to an overall decrease in stress that lasts beyond the moment.
Life stress impacts our running. Putting big miles on a stressed system can lead to burnout or injury. By using mindfulness and decreasing overall stress, runners can safely stick with their training plan as prescribed or even increase their capacity for running-specific stress.
Mindfulness changes our brains. A study out of Harvard used brain imaging to demonstrate that mindfulness produces helpful structural changes in the brain after just 8 weeks of about 30 minutes/day of mindfulness meditation practice. Changes were identified in the prefrontal cortex and anterior cingulate cortex—both of which play major roles in executive functioning, impulse control and decision making. Mindfulness promotes neuroplasticity, which means by practicing mindfulness we can more easily learn new things and integrate new ways of thinking. We can change things we don’t like--maybe transform our inner critic to an inner coach or learn how to bomb downhill.
Mindfulness is a fantastic recovery tool. While the jury is still out on CBD bath bombs, there’s no question that mindfulness decreases cortisol, improve sleep, and reduce inflammation. Those physiological benefits paired with the mindful attitudes such as patience, non-judgement, and non-striving, support recovery between workouts after races, and during injury.

HOW CAN I GET STARTED?
Building capacity for mindfulness is just like building endurance for running—start small, stay consistent, and increase incrementally.   
Start by integrating mindfulness into your running. You can use strategies like body scans or progressive muscle relaxation to take stock of how you are feeling and reduce tension before you even head out the door. During your run, set aside 3-5 minutes mid-run to focus on the pattern of your breathing or your feet hitting the ground. You don’t have to aim for an entire mindful run—just shift your attention for a few minutes.

Outside of running, look for regular pockets of time where you can implement a pause, a mindful return to the body. To have a “mindful moment”, simply intentionally shift your focus to the sensation of your breath or use your senses to notice the environment around you. When your mind shifts to thoughts or discomfort, come back to the breath/sense.   Sitting for a few breath cycles before eating, pausing when transitioning from work to home or home to work, or being mindful for a few minutes before bed are all simple ways to add mindfulness into your day without impacting your busy schedule.

When you are ready to start with more formal mindful meditation, consider using guided meditations, visualizations, or movement meditations. These can feel more comfortable than sitting in silence trying to quiet your mind.

Start with an achievable goal of 3 days/week and 5-10 minutes/session for the first week. Once you’ve done that for a couple of weeks, increase EITHER the session time OR the frequency. If you miss a day, it’s OK! There’s always tomorrow. Try not to let a missed day become a missed week.
Mindfulness is an accessible tool—there’s no cost, no equipment, and it doesn’t require much in the way of technical skills.  But for runners who are more comfortable with movement than stillness, it feels inaccessible. It doesn’t involve the dopamine hits we get from moving our bodies or from seeing a shiny Strava medal .  In a world where data, metric and measurable results guide our training, mindfulness asks us to blindly trust an uncomfortable process. And when we are starting out it can feel really hard. Hard enough that we mistake being a novice with “being bad at mindfulness” and give up before we can begin to reap the benefits. One study demonstrated that people would literally prefer to endure an electric shock than sit in stillness with their feelings. Knowing it is supposed to be challenging can help you manage expectations. When (not if) it is challenging, be kind to yourself!  Take it one day and one practice at a time. Remember that the research shows changes after 8 weeks of regular practice---consistency and patience are key.

WHERE CAN I LEARN MORE?
As you look at your training program or think about preparing for your upcoming race, don’t forget about your brain!  Your mind has the capacity to change and the need to rest just like the other parts of your body. These resources can help you incorporate mindfulness into your life/training.

1. My Mindfulness For Runners Course is available for download. Engage with it at your own pace and schedule. It’s full of tangible resources, fun science, and real-life strategies. Use code TRAININGBLOCK for 25% off.
2. Download free meditation apps or ones that offer free 7 day trials and find what works for you and what doesn’t. (examples: Headspace, Calm, Waking Up, Nike Training App)
3. Spotify and YouTube are full of free meditations—don’t give up until you find something that works for you.
4. Readings and resources from; Sakyong Mipham, Thich Nhat Hanh, John Kabat-Zinn, Tara Brac

How to run a fartlek

One of the most common questions we get from runners is how to run a fartlek workout. This is not surprising given that ambiguity and uncertainty have surrounded fartleks since their birth in Sweden in the 1930s. 
Our endeavor here will be to make abundantly clear how to run a fartlek workout successfully. To accomplish this, we will need to separate fartleks from other workout types as well as define clearly the purpose and spirit of the workout.

Delineating Common Workout Types
It might be said that there are really only two types of workouts at a fundamental level. Nuances aside, there are workouts that involve sustained running at a given pace, and there are workouts that involve some kind of change of pace or intervals of varying efforts. This being true, fartleks fall under the category of interval types of workouts.
More accurately, though, fartlek and interval are somewhat interchangeable terms. A fartlek workout is really just any combination of faster and slower running over a given duration. What makes it different from other interval workouts has more to do with purpose than form. 
Hearkening back to its origin, a fartlek is a playtime run (recall the translation of the word fartlek: “speed play”). To apply that properly, a runner must then use a fartlek workout differently than other intervals. Primarily, a runner must seek to engage a spectrum of efforts within a single workout along with easy running rest periods.
Additionally, at its core, a fartlek ought to differ from other workouts by being more precisely attuned to each athlete, and not merely to each athlete but even more to each athlete in each instance. One might therefore note that the fartlek workout is the runner’s tool to getting exactly what is needed in the moment of needing it.

Achieving the Spirit of the Fartlek Workout
Understanding that fartleks are both highly variable and differentiated, the aforementioned ambiguity and uncertainty makes perfect sense. Or maybe makes no sense at all. 
This is also why when seeking to run a fartlek, the question “But what exactly should I do?” is actually not very easy to answer. It’s also simply bad practice to try to answer it. (Which is why, for those of you whom we have coached, we are unapologetic in providing an unsatisfactory answer! But fear not and read on…)
First, the answer has to begin with the purpose and spirit of how to run a fartlek workout. The format in general terms is playing with speed across various efforts and paces, so the central purpose, therefore, is neuromuscular. Additionally, the goal of the workout is to provide the stimulation needed at that moment for that runner. Therefore, the spirit of the workout is to respond to the body’s needs both in terms of needs identified in recent training and needs manifesting as the workout unfolds.
This is incredibly challenging!
We are suggesting that in order to achieve the purpose and spirit of the workout, we need to be able to make in-workout decisions and adjustments without the input from a coach. The best coaching during a fartlek looks like this: “How are you feeling? Does it feel better to go faster or slow it down a little? Do you need to jog longer between pace changes? Do you want to try throwing in something different?”
Coaching someone through a fartlek requires knowing realtime reactions to questions like these. That’s not especially practical, though.
With this in mind, we really need an aid to achieving the intuitive goal without so much thinking.

A Framework for Executing an Effective Fartlek Workout
Let’s build a simple yet highly effective framework. With this in mind, we should be able to successfully achieve the goal very nearly every time we run a fartlek. The framework involves making 3 decisions on repeat in response to two simple physiological cues.

Decision 1: Should I pick it up now?
CUE: Am I feeling fresh enough to go fast?
As you are jogging (be it the warmup before the workout begins or a rest jog between faster sections), once you begin to feel fully recovered and comfortable, your body should be ready for another pace change. All you need to determine here is whether it’s time to get up and go.

Decision 2: How fast should I go?
Once you start accelerating (or perhaps just before), determine how fast you want to go. This is not complicated because the intent is variety. Whatever you did most recently, do something a little different. This can range from strong steady effort running up to and including short wind sprints (we call them leg speed  or running form strides).

Decision 3: Should I slow down now?
CUE: Are my legs starting to fatigue at this current effort?
As you push at the increased effort, monitor how you are feeling. Naturally, if you decided in #2 to go substantially faster, you are going to fatigue sooner. The key is slowing down before you cannot handle the pace any more.
Then repeat!
A fartlek can occupy a total duration of a wide spectrum, depending on the nature of the need (though we do not recommend doing fartleks for longer than 60 minutes total, including the jogging rest between). As you execute the workout, simply focus on how you are feeling, interspersing lots of variety along with plenty of easy jogging between faster efforts. 

Why This is Helpful
Knowing now how to effectively implement fartleks, we ought to reflect a moment on why this type of workout offers value to our training. In a word, variety. 
Fartleks are the Swiss Army Knife workout (yes, yes - I know it’s Swedish). They provide the opportunity to fill gaps in many ways because by their very nature, they can be whatever we want or need them to be in a given moment. For example, during such periods as general base training or conditioning work, fartleks provide a chance for some light and quick sessions without excessively taxing the energy system like hard interval workouts are prone to do. Additionally, during a more intense race-specific coordination period, fartleks are a great chance to keep in touch with training elements that might not be as present.
This is why fartleks are neuromuscular in nature and also why variety as well as substantial jogging periods are essential.
Now, don’t just take our word for it. Give that framework a try on your next fartlek session, then let us know how it went!

By Zach Ripley, running coach and co-founder of AtoZrunning
Originally published on AtoZrunning.com

Video: Quality Practice

Quality Practice with Dr. Brian Zuleger, CMPC

https://coachesinsider.com/track-x-country/quality-practice-with-dr-brian-zuleger-cmpc-missouri-institute-for-positive-coaching/

Watch as Coach explains that a quality practice is practicing with a purpose to prepare to perform. Athletes and coaches need to focus on what are they doing to prepare to be effective in practice or team competition. Some athletes and coaches are good in practice but not so in competition and this is usually a result of not preparing for the performance environment which relates to a quality practice. Coach will discuss the illusion of balance, stating that if you are chasing success there will be a lack of balance in your life.

 

Strength Running Podcast 163- Professor Brian Zuleger

163. Professor Brian Zuleger on the Mental Strengths of Youth, Community, and Fun
Brian Zuleger is a professor of sport psychology at Adams State University, where he is also the mental strength coach for the Cross Country and Track and Field teams. He works directly with athletes in an integrative, holistic approach.
Brian is a certified Exercise Physiologist from the American College of Sports Medicine. He applies his education with the athletes he works with as a personal trainer and coach.
We discuss the partnership that he has with athletes, the skills that they focus on, and their unique psychology. We talk about the advantages and disadvantages of the youthful mindset, as well as what adult runners can take away.
We also talk about:
Healthy ways to view competition Temptation of numbers-driven outcomes Getting unstuck after a bad workout Advantages of having a team Show Links & Resources:
Check out Brian's website Connect on Instagram Sign up for our free course on confidence, focus, and mental toughness Thank you  to the  Run Smarter Podcast!
The Run Smarter Podcast is our newest sponsor that I know you'll love. Hosted by Brodie Sharpe, an expert in physiology, it aims to bridge the information gap for recreational runners and the field of physiotherapy.
Brodie is an expert in this and is passionate about helping runners perform their best. Alongside the valuable resources shared in the Run Smarter Podcast, he offers online physiotherapy to help runners recovery from injuries.
When I joined Brodie to discuss how to create the best training plan, I was impressed with his thoughtful questions and commitment to science-based information. Check out more of his episodes on The Run Smarter Podcast and subscribe to get the newest ones. I know you'll really enjoy it!

Active Isolated Flexibility (guided routine)

Active Isolated Flexibility (AIF) was originally popularized by Jim and Phil Wharton as a method for effectively and intuitively increasing mobility. As an approach, AIF leverages the agonist/antagonist pairing of muscle groups to functionally contract and elongate muscle tissues. Watch this video for a complete guided routine of AIF especially attuned to runners.
For more, visit atozrunning.com  

True Strength Training

It’s fair to say that most runners today know that they need to do some form of strength training in order to perform better and reduce injury risk. It is also pretty common knowledge that running hills never did qualify as true strength training;) However, when I see patients in my clinic and runners in our club, there are still many misconceptions about what true strength training is and how to incorporate it into your run program. If you are training for a 5K, would you run a 20 mile long run? Probably not. If you are training for a marathon, are you going to spend lots of time doing 100m sprints with full recovery? While a little speed work does help, it would not be enough to get you acorss 26.2 miles. Let’s see if we can shed some light on what effective strength training for runners might look like. Just a heads up that I hate being told the first 2 steps of a 5 steps process and then “you’ll figure it out”, so there is a lot of info in here so you can actually safely apply the following concepts tomorrow.

Let’s start with a few definitions:
Strength: the ability to move a load a certain distance. If you can lift 150lbs off the floor and someone else can only do 100lbs, you are stronger by definition. (to improve pure strength, lifting 80-90% of 1 rep max, having 1-2 reps in reserve, doing only 3-5 sets of 3-5 reps with 3-5 MINUTES of TOTAL rest, that’s the hardest part for us endurance runners :)
Muscle Endurance: the ability to move a certain load over a certain amount of time, with more time being equated to better endurance. This time component can be measured in time or repetitions. (often achieved in the 3 sets of 20 type ranges, with a lot of reps in reserve)
Hypertrophy: in the context of our muscles this means growth in size of muscles. More size does have the ability to become more strength, though there is an optimal balance in size and the weight that it means you are carrying on your body. (lifting 8-12 reps at 70% of 1 rep max/ about 3 reps in reserve is the sweet spot here)
Power: is load (strength) over time, the ability to move a load quickly. If you and a friend both move 150lbs  from floor to waist, but you do it faster, you are more powerful. You can improve power by moving the same load even faster, OR by moving a heavier load as fast as you did the lighter load. One of these variables has a lot more potential to change than the other… the amount of load, or strength. (lifting at 50% of 1 rep max but focusing on speed is crucial here. With power training, a dab'll do ya, so only a few reps and sets are needed, similar to pure strength, but even longer rest time. Also, plyometric work can shine here, think jumping tasks of any kind).

Running is mostly a sport of power trying to be sustained over time. A rare combination of power and endurance. Each stride is all about power, but we need to be able to continue this powerful single leg hop for many many miles. The goal of a good strength program should be to develop pure strength in your sagittal plane (forwards/ backwards plane) in order to make you more powerful with each stride, while also addressing decent endurance factors to keep that power coming over and over. Now, if you only weigh 150lbs, and can only squat 135 lbs., even at 30 reps (3 sets of 10 sound familiar to everyone?) there is only so much power you can generate to propel yourself forward. But if we can increase that squat to 225lbs over the course of several months, it becomes really easy to push 150lbs with each stride, and takes less energy in each stride to do that, leaving you more energy to go faster and longer. So how do we get there? 

This is where most runners are not aware that their program is probably heavily under-dosing the stimulus (read weight/ load) necessary to do this. We need to have seasons where we lift heavy, just as when we go high mileage and intensity a certain number of weeks out from a key race so we have our body prepared for the rigors of race day. We want to consider the 35 rule: 3-5 sets of 3-5 reps with 3-5 minutes rest in between, done at 80-90% of 1 rep max. So if you max out your deadlift at 150lbs, you want to shoot for 4x4 at about 130lbs. You will have only done 16 total reps

Pure strength has very little to do with the ability of the muscle fibers themselves, but rather the nerve to said muscle recruiting ALL the fibers to participate. It’s like the 80-20 rule being fixed. (80% of the work is done by 20% of the group, while the other 80% of the people cheer on the first 20%). By recruiting more muscle fibers the ones already working do not have to do more work, instead they do what they have been doing, but help arrives to move the load. So when you tap into pure strength training sections of your run strength program, you usually end up with LESS soreness than in the endurance and hypertrophy stages. And note the 2-3 sets of 8-12 reps for hypertrophy… if you have started lifting heavier, but stayed in that range, you are actually in the sweet spot for putting on that bulk that I often hear is not desired. If I had a nickel for every time a runner told me they did not lift heavy because they did not want to bulk up, my 5 year old’s college fund would be near complete already.
A couple quick thoughts on benefits of pure strength training:

1. You become stronger and faster
2. Your bones become MORE dense than running can offer, like SIGNIFICANTLY more
3. Your tendons and ligaments become better hydrated
4. In general your body becomes more robust and ready to handle the demands of the pounding that running is, reducing injury risk.
5. If you are a trail runner, you have better ability to skip around on the technical terrain like a mountain goat, reacting to whatever comes underfoot

sample strength training program

Strength routine for runners:
(this is NOT an exhaustive list of all the best lifts for runners, but does do a good job of challenging multiple planes of movement plus addressing a couple big lifts to get stronger legs and glutes and back. Shoot for 2x/ week with this routine.

Running EMOM:
Run strength EMOM (every minute on the minute: start a stopwatch, at each minute, switch to the other side or the next exercise. When you get to the last exercise, go back to the beginning)

side lying plank (with leg lift) Right
side lying plank (with leg lift) Left
https://www.youtube.com/watch?v=ZR84WQVhdIE
OR
banded toe taps Right
banded toe taps Left
https://www.youtube.com/watch?v=fIPgv73d0gU

reverse step down Right
reverse step down left
https://www.youtube.com/watch?v=KTA7h9bJ4V8
OR
single leg deadlift Right
Single leg deadlift Left
https://www.youtube.com/watch?v=84hrdsHgDuQ&t=130s

Pallof press Right
Pallof press Left
https://www.youtube.com/watch?v=JtMok3ON0lQ
OR
Chaos pallof press to each side
https://www.youtube.com/watch?v=aCAv2_3Bas0

Reverse plank
https://www.youtube.com/watch?v=ZNAxdJ6Bt00
OR
banded SLR
https://www.youtube.com/watch?v=KYb6M2mvtAU&list=PLVD4umAhljU9mq3csn_OulWVJaMkwRRHJ&index=4

45 seconds on, 15 seconds off each exercise for a total of 14 minutes

Above is a great first half of the workout routine. Rest an honest 3 minutes, then follow with emphasis on 1 of the following lifts:
Squat: https://www.youtube.com/watch?v=U3HlEF_E9fo&t=95s
Romanian Deadlift: https://www.youtube.com/watch?v=ytGaGIn3SjE&t=421s (key difference vs. regular deadlift https://www.youtube.com/watch?v=4usyq_IHdkg&t=24s, do the Romanian version at first is recommended, but the conventional deadlift is an amazing full body load)
Bulgarian split squat:https://www.youtube.com/watch?v=-4LVK1crLSw&t=345s
Weighted hip thrust: https://www.youtube.com/watch?v=Zp26q4BY5HE

First 2 months: shoot for 3 sets of 15 with 5 reps in reserve (so if I said actually you have to do 21, you would say, you could do 20, but not 21). You can often figure out what this is using a 1 rep max calculator. On your first day, on the last set, go for an As Many Reps As Possible (AMRAP) round and see how many you can do with whatever weight you chose. Then use this calculator to help dial in roughly how much weight you should do to only have about 5 reps in reserve:
https://strengthlevel.com/one-rep-max-calculator
(just know that if you crank out a LOT of reps, this becomes less accurate the more reps you get, so hitting more than 25-30 reps means you need to try again some other day).

After 2 months: shoot for 2-3 sets of 8-10 reps at 2-3 reps in reserve to shoot for a bit more of a strength gain with some hypertrophy. If you are new to this kind of intensity with your strength programs, I recommend one 2 month session here. After this…

Think about the 35 rule: 3-5 sets of 3-5 reps with 3-5 minutes rest at a load that feels like there is 1 rep in reserve. This is a great place to build pure muscular strength with less likelihood of adding a lot of bulk. This should be the bulk of the strength work on a key lift each session. The low reps total (4x 3 reps is only 12 total reps), leaves your muscles strained (as in challenged, not injured)  and therefore stimulated for responding by getting stronger, without too much load and fatigue overall so you can hit the big mileages in your running program.

Rotate throught about 2 months of each set of paramters for the big lift (3x15, 3x 8-12, 3-5x3-5).
 

Dr. Brian Zuleger: Mental Performance Training in Track and Field

https://podcasts.apple.com/us/podcast/dr-brian-zuleger-mental-performance-training-in-track/id1544810395?i=1000566977523

Sport is chaotic. During an athletic career, athletes are tasked with making a lot of decisions that compound over time and will dictate their trajectory.
Dr. Brian Zuleger, is a Mental Performance Consultant who has worked with Track and Field athletes, both as a Coach and Sports Psychologist.
In this episode, Dr. Zuleger explains how Mental Performance Training can equip athletes to navigate the chaos and remove the often self-imposed barriers that separate them from their better selves.

Mental Performance Coaching Process

Mental Performance Coaching Process
Rapport, Roles and Expectations

• Establish and maintain rapport with the individual/s.
• Explain the role of a mental strength coach within the specific setting or system with individual/s and important others.
• Explain what is expected of the individual.
• Explain/describe the mental training process.
• Explain your mental strength coaching philosophy (e.g. holistic approach)
• Discuss and/or clarify the mental training process (e.g., Informed consent, documentation, contract, confidentiality, limits of availability) to help individual/s make informed decisions.

• Obtain and summarize individual, team/group and organizational assessment data and information pertaining to performance via interviews, direct observation, the administration of questionnaires and standardized tests, collaboration with other professionals, etc. Assessment includes but is not limited to:
• Observing performance
• Obtaining a sport history
• Obtaining collateral assessment data and information
• Determining important factors in the performance environment (e.g., organizational characteristics (leadership, culture, dynamics), relationships with coaches)
• Identifying personal characteristics (e.g., family, SES, social values, personality, cognitive ability, motivation)
• Identifying perceived individual and organizational strengths and weaknesses
• Obtaining a health and injury history
• Identifying significant life events that may be affecting performance
• Identifying/assessing individual/s beliefs and biases about sport psychology

• Integrate and evaluate assessment data within a theoretical framework of performance excellence, evidence-based practice and professional judgment.
• Collaborate with the individual/s, and when appropriate, members of the performance team (e.g., coaches, colleagues, and other professionals) to formulate a plan to determine and prioritize goals and desired outcomes.
• Identify personal and systemic resources and barriers related to the achievement of goals and desired outcomes.

• Implement a performance plan that looks at how mental skills potential blend together to form greater mental competencies [e.g. Focus (mindfulness, self-talk, concentration)]
• Implement a performance plan combining awareness, education and action to facilitate achievement of desired outcomes.
• Implement a performance plan providing and obtaining feedback as the individual/s work toward achieving the goals and desired outcomes.

• Assess progress, reset goals and/or revise implementation strategies and techniques either as part of a continuing process/relationship (e.g., on continuing basis, yearly, season-by-season) or as part of assisting individual/s in making progress towards established goals.
• When possible and appropriate, obtain feedback from individual/s on consultant effectiveness.
• When ethically appropriate, obtain feedback from coaches/leadership regarding performer utilization of mental skills training and mental strength coach effectiveness.
• Consolidate progress and conclude the professional relationship when appropriate based upon people working with and/or professional opinion.

• Engage in activities to maintain and enhance professional competence.
• Practice in a manner consistent with applicable laws, regulations and the AASP Code of Ethical Principles and Standards.
• Engage in a process of self-reflective practice that includes a process of continuous learning.
• Recognize their own biases, stereotypes and misconceptions to prevent them from interfering with their relationships with individual/s.
• Recognize the limits of their knowledge and skills and accordingly refer individuals to, or seek collaboration with other qualified professionals, as necessary.
• Engage in activities that enhance their knowledge and skills that relate to their supervision of professional colleagues seeking certification.

What is Cupping?

Follow @Alpine Fit for vetted exercises, quick tips, and easy recommendations on how to get out of pain and get back to what you love. Plus, check out our FREE Shoulder, Knee, Back, and Running Guides over at www.AlpineFitPT.com

Tips for Keeping Healthy in the Summer

Follow @Alpine Fit for vetted exercises, quick tips, and easy recommendations on how to get out of pain and get back to what you love. Plus, check out our FREE Shoulder, Knee, Back, and Running Guides over at www.AlpineFitPT.com

What is Dry Needling?

Follow @Alpine Fit for vetted exercises, quick tips, and easy recommendations on how to get out of pain and get back to what you love. Plus, check out our FREE Shoulder, Knee, Back, and Running Guides over at www.AlpineFitPT.com

Treating Pandemic Stress and Pain with Acupuncture

FULL ARTICLE: Treating Pandemic Stress and Pain with Acupuncture
by Shane Rutkowski, L.Ac., Dipl. Ac.
     Imagine if you will, a smoke alarm that won’t stop going off. One of two things might happen. You’d either eventually attenuate to it and not notice any alarms or you’d become hypersensitive and completely on edge— jumping at every little sound. We don’t want to live in a world where alarm bells are constantly ringing but we also don’t want to rip the smoke alarm out of the wall either. Now imagine that a ball or a bird is flying towards your head—You tense in anticipation. Then, the object either hits or misses you, at which point you’d physically relax as the threat has passed. But what can you do if the threat isn’t physical? In this case, the body doesn’t always receive the signal that the threat has passed and therefore doesn’t know to relax. What then? That’s where acupuncture comes into play.
  
How does stress affect the body?   
     Stress and stressors on the body are helpful in the short term. The alarm clock, the morning sun, will increase cortisol and get us out of bed and ready to start the day. An unexpected car horn may give us enough adrenaline to cross the street quickly, increasing blood flow to muscles and the heart’s ability to get oxygen to those muscles. Strength training and exercise are other good and necessary stresses on the body that build up our resistance over time. The body’s short-term response to stress, pain, and yes even the idea of a painful or stressful situation is one that in a perfect world returns to a state of homeostasis after the threat has passed. The body's flight, fight, or fawn cycle should be complete and return to neutral (Duncan, 2019). But what happens when the danger doesn’t pass, what happens almost 2.5 years into the COVID-19 pandemic? What happens when we push beyond our zones of resiliency. We know that chronic stress will result in very real biological responses that can alter our ability to bounce back over time. “Recent studies have revealed heightened levels of anxiety and depression during the ongoing pandemic, with specific factors such as social or lower economic resources influencing stress perception (Pfeifer et al., 2021).”

  So what can happen with prolonged chronic stress?
“Prolonged or exaggerated response to pain or non–pain-related stressors may intensify sympathetic and neuroendocrine activity, exhaust cortisol, and perpetuate widespread pain and inflammation. Elevated cortisol levels following acute stress may facilitate the consolidation of fear-based emotional memories and condition a sensitized physiologic stress response.”
In other words, chronic stress can lead to chronic pain and get stuck in a cycle. This in turn leads to widespread inflammation, depletion of serotonin, or increased autoimmune hypersensitivities (Hannibal & Bishop, 2014). Clinically, in addition to chronic pain, I’ve seen an uptick in menstrual irregularities, insomnia, digestive issues, migraines, and headaches, usually with accompanying neck or low back pain.
     
How can we relate this to acupuncture?
     Acupuncture has the unique ability to help the body complete the stress cycle. This allows for a break in the pain cycle and a return to a state of self-regulation by concurrently addressing the physical and emotional body. Alaine Duncan’s work, The Tao of Trauma relates the body's Self Protective Response to the Taoist Five Elements. One example of this is the association of fear with the water element and in turn the kidneys. If we relate this to the body’s adrenal response and the HPA-Axis, there is a perfect correlation and marriage of eastern and western perspectives. As discussed above we can deplete and exhaust cortisol in the body, just as we can over boil a pot of water and start to burn the pot itself. This can be applied to the kidneys' effect on the heart and the heart's effect on the kidney, in other words, the relationship between fire and water or joy and fear.  
     Our bodies are hardwired for survival. Over time, our brains have evolved methods of interpreting, cataloging, and maintaining information to keep us alive. This survival-based hardware is intriguing and very necessary. All of these unconscious biological processes are very much tied into how much we perceive our environment to be safe. The last few years have taken a toll on our emotional and physical well-being. An important point to remember is that these stressors, threats, or perceptions of danger, whether real or imagined, have a very real physiological response. It’s why watching scary movies can be fun, but also cause very real muscle contractions when the jump scare occurs (Tremblay, 2019). It is also why East Asian Medicine incorporates the external environment and emotional landscape into its orthopedic assessments.
     It’s why I refer to my practice at Sláinte Acupuncture as integrative. There does not have to be a hard divide between western science and eastern medicine. Acupuncture is a powerful modality that can help regulate the physiological and in turn the emotional body by helping to regulate the nervous system back to a place of healthy regulation.

How can acupuncture help to regulate the sympathetic nervous system?
      I do this in a few ways. The first is through asking. I do a thorough intake of medical history. I specialize in orthopedics but want to know about the internal environment and how the whole system functions. Because the ultimate goal is one of homeostasis and resiliency (Xu et al., 2018). Patients often think they have to separate orthopedic concerns from internal issues regarding sleep, digestion, elimination, and menstruation. Somatovisceral and visceral-somatic pathways or the way the body affects the organs and the way the organs affect the body are a topic for another essay but know that an informed practitioner is treating the whole person and not just one symptom.
                                                  Anxiety does not cause stomach aches; rather, feelings of anxiety and stomach aches are both ways that human brains                                                       
                                                  make sense of physical discomfort. There is no such thing as a purely mental cause, because every mental experience has
                                                  roots in the physical budgeting of your body. This is one reason physical actions … can be surprisingly helpful in
                                                  addressing problems we traditionally view as psychological. (Barrett, 2020)
     The next way is through palpation or touch. By palpating the channels and cross fiber palpating muscles, I can find areas of excess or deficiency or hyper or hypotonicity in the muscles. One way that stimulating acupuncture points, on a micro level can help to act on a macro level, is by acting as the stimulus in which our body gets stuck anticipating. It can also stimulate a motor point or trigger points, elicit neuromuscular fasciculations, and reset a muscle to its appropriate length. Especially if the muscle is stuck short or long often bracing or in anticipation or inhibited in firing due to pain avoidance (Ellingsen et al., 2018). 

#MoreThanJustNeedles
     At Sláinte we use needles, yes, but every treatment is custom-tailored in real-time to the patient and how they are responding to treatment. I’m trained in multiple styles of acupuncture and various non-needle techniques so I feel confident that each patient can receive the best treatment for them. This can be through, e-stim or electro-acupuncture, acupressure, somatics, amma massage, tui na, gua sha (or scraping), moxibustion, infrared heat therapy, or cupping. Everybody is different. Every body is different. It’s my job to meet my patients where they are at but to never discount the environment in which they find themselves.
     We know touch can be very therapeutic. On the other hand, one common complaint I hear from patients is neck and trap tension that doesn’t resolve with massage therapy, chiropractic, or other manual therapies. This is because without addressing the underlying nervous system, without considering the person in their environment, our bodies will continue to brace and protect our vital organs and vessels. Acupuncture has the unique ability to ground a patient and disengage this process of bracing/anticipation. We bring about parasympathetic regulation through controlled and conscious touch and intervention. By using palpation we can use the body’s real-time feedback to elicit changes in muscle tone and lessen pain at the site of chief complaint with the use of distal acupuncture points before engaging in local intervention. There’s no need to meet trauma with more trauma. The body is sending us these signals for a reason and it is our job to interpret why and gently lead the body back to a place of balance and safety. Think back to the bird flying at your head. Step one is always to get the body to feel safe and relaxed, then the door is open for local intervention with a greater chance for the benefits of the treatment to last.
      As pack animals, we regulate and attune our nervous systems with those around us. So resonating with whatever practitioner you choose to work with is just as important as the treatment performed. If you have any questions regarding how acupuncture or any of the above-mentioned modalities might aid you in regulating your nervous system, don’t hesitate to reach out. I can be reached at www.SlainteAcupuncture.com or info@Slainteacupuncture.com

Sláinte: pronounced SLAHN-chə is Gaelic for health. Derived from the old Irish noun slan which means safe, whole, or health, today it is used as a greeting or a toast.


References and Works Cited
Barrett, L. F. (2020, November 23). Your Brain is Not For Thinking. The New York Times. Retrieved July 17, 2022, from https://www.nytimes.com/2020/11/23/opinion/brain-neuroscience-stress.html
Duncan, Alaine D. (2019). Tao of Trauma: A Practitioner's Guide for Integrating Five Element Theory and Trauma Treatment. North Atlantic Books.
Ellingsen, D.-M., Napadow, V., Protsenko, E., Mawla, I., Kowalski, M. H., Swensen, D., O'Dwyer-Swensen, D., Edwards, R. R., Kettner, N., & Loggia, M. L. (2018, November). Brain mechanisms of anticipated painful movements and their modulation by manual therapy in chronic low back pain. The journal of pain. Retrieved July 17, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220681/
Hampton, T. (2022, February 23). Pandemic Stress and the Brain. Pandemic Stress and the Brain. Retrieved July 17, 2022, from https://hms.harvard.edu/news/pandemic-stress-brain
Hannibal, K. E., & Bishop, M. D. (2014, December 9). Chronic stress, cortisol dysfunction, and pain: A psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical therapy. Retrieved July 17, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/
Pfeifer, L. S., Heyers, K., Ocklenburg, S., & Wolf, O. T. (2021, September 29). Stress research during the COVID-19 pandemic and beyond. Neuroscience & Biobehavioral Reviews. Retrieved July 17, 2022, from https://www.sciencedirect.com/science/article/pii/S0149763421004267
Tremblay, S. (2019, March 2). Your Body on A Horror movie. Sciencing. Retrieved July 17, 2022, from https://sciencing.com/your-body-on-a-horror-movie-13714006.html
Xu, Y., Guo, Y., Song, Y., Zhang, K., Zhang, Y., Li, Q., Hong, S., Liu, Y., & Guo, Y. (2018, February 1). A new theory for acupuncture: Promoting robust regulation. Journal of Acupuncture and Meridian Studies. Retrieved July 17, 2022, from https://www.sciencedirect.com/science/article/pii/S2005290117301401
Zhang, R., Lao, L., Ren, K., & Berman, B. M. (2014, February 1). Mechanisms of acupuncture–electroacupuncture on persistent pain. American Society of Anesthesiologists. Retrieved July 17, 2022, from https://pubs.asahq.org/anesthesiology/article/120/2/482/11811/Mechanisms-of-Acupuncture-Electroacupuncture-on


 

Annual Check-Ups: Don't Forget a Visit to Your Favorite Physical Therapist

What if we could prevent the majority of injuries, aches, and pains? If we could, it would lead to more mobility, less pain, and improved function in recreational activities, job duties, and daily tasks. For active Coloradans, that means more mountain biking in the mountains, running through City Park or Wash Park, hiking through the Rocky Mountains, or walking through Downtown Denver. Turns out, we can often prevent overuse injuries, aches and pains! Some may expect an annual physical at the primary care physician to address this, but most physicians don't have the time, or the musculoskeletal expertise, to dig deeper into mild joint pain or chronic muscle soreness. If they do, usually generic advice to RICE or "don't do fill in the blank" advice is provided. If you are lucky, you might get a referral to physical therapy. So why not start with a physical therapist before the pain and soreness even starts?

In Colorado, you can make an appointment directly with a physical therapist without a prescription from a doctor; this is called direct access. Physical therapists are experts in musculoskeletal conditions - a perfect fit to address aches and pains! Most mild aches and pains are due to alerted biomechanics and over-use/over-stress of the joint and tissue. Recognizing compensatory, or "off", movement patterns is the first step to fixing them. Usually a combination of joint mobilizations, targeted exercises, soft tissue work, and gradual progression of load (i.e. weight, running distance, etc.) is all it takes to break the cycle and reduce pain.
Client Examples:

1. A 30 year old client presented with weakness through the right glutes (as compared to the left) and complained of right knee pain with running anything longer than 3 miles. He took a 4 week break from running (per his doctor's advice) but when he started running again, the knee pain was still present. Upon evaluation, his right glutes were weak due to lack of hip extension and poor pelvic control. A simple exercise routine to stretch through hip flexors, strengthen the glutes and inner thighs (adductors) in multiple planes of movement, core strength routine, and plyometrics to improve landing control is all it took to fix the movement dysfunction and return to running pain-free!
2. An active and fit 45 year old client does yoga, runs, lifts weights, and bikes and wants to keep healthy. A thurough musculoskeletal screen indicates mild shoulder and spine limitations as well as end range ankle stiffness limiting squat depth and balance control. A custom home program involving right shoulder self mobilization, thoracic mobility exercises, core stabilization, and ankle mobility/mobilization exercises is the key to keeping him healthy and participating in his recreational activities pain-free.
3. A 50 year old active recreational athlete increased mountain biking efforts this past month to prepare for a 7 day stage race. Her nagging low back pain with 2+ hours of saddle time presents as mild lumbar disc irritation associated with decreased hip mobility and recent changes to the saddle change and positioning. A few mobility exercises and bike fit suggestion leads to 80% of the pain reduction within 1 week!

What is "Physical Therapy" Anyway?

What is physical therapy?
A simple question that doesn't have a simple answer according to a recent mini-research study published earlier this year in Musculoskeletal Science & Practice. (Read the summary here). This study asked 25 subjects what their expectations of physical therapy were prior to their attending their first visit, the initial evaluation. The results concluded that the perception of the role of physical therapy in a healthcare plan was vague and unclear. Specifically, most patients did not expect their treatment to include manual therapy. With so much confusion, why go see a physical therapist?

According to the American Physical Therapist Association, "physical therapists are movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education." According to Webster's Dictionary, physical therapy is "the treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery." Both are appropriate definitions but leave out what to really expect when you're in pain, seeking help and relief, and trying to get back to your desired activities.
Anatomy of a good physical therapy experience

1. Visits revolve around you, your limitations, and your goals.
2. Medical history is discussed along with sleep patterns, nutrition, exercise habits, and other lifestyle habits that can contribute to inflammation and healing.
3. A thorough exam is performed at the first visit and on a regular basis to determine impairments and progress.
4. Examination findings are discussed at length with the opportunity to ask plenty of questions to clarify.
5. A variety of treatment methods are used based on your current pain and limitations and what your ultimate goals are. i.e. if you weight lift or run, treatment should prepare you for returning to your desired activity level.
6. Strengthening, manual therapy, lifestyle modifications, dry needling, joint mobilizations, weight lifting, and mobility can all be part of your therapy session and your home program. Treatment strategies should vary based on your examination findings and your goals.
7. You are the director of your care - your physical therapist (and all other providers) should be receptive of feedback and ideas.

Fall Marathons - Preparation Starts NOW!

Spring weather means more outdoor running, especially here in Denver, Colorado! Springtime is also the best time to start preparing for big races in the Fall, especially if it is big race like NYC marathon, Chicago marathon, Boulder marathon, or a 70.3 or full IRONMAN. A lot of attention is put on the 12-16 week training plan leading up to race-day, but 5-6 months pre-race is the prefect time to set a strong foundation of strength and mobility to build on.

Strength Training
Full body, heavy weight lifting is necessary to build muscle strength needed to run longer and faster, but it also serves to build tendon strength and resiliency. This is key for long-distance athletes who are prone to issues like Achilles tendonitis, IT band pain, or plantar fasciitis.
Examples of full body weight lifting exercises include: squat, deadlift, weighted lunge, pull-ups, decline push-ups, bench press, rows, kettlebell swings, and weighted step-ups.

Plyometrics
Develop power, build strength, and increase endurance with plyometrics, also known as jumping exercises. Plyometrics are a great addition to strength training because jumping loads muscles and tendons in a unique way. Starting a new type of exercise can be daunting at first, so it is important to start slow and ensure good, safe form to avoid injury or over-loading joints.
Example of a beginning plyometric routine: 20 sec intervals of bilateral bunny hops in place, front to back, and side to side; repeat for 3-5 rounds.

Cross Training
Running involves moving through a forward plane of motion but requires strength and control in 3 planes of motion. Improving muscle strength and activation in the rotational plane and the side to side plane helps improve running stride efficiency. Cross training is a great way to use muscles in a variety of ways in all 3 planes of motion.
Examples of cross training to maximize movement variety: tennis, soccer, volleyball, racquetball, and swimming.

Finding & Addressing Imbalances
There are about 600 muscles and 360 joints in the human body. Movement asymmetries are common and can be caused by previous injuries or habitual movement patterns. Finding balance between the right and left legs is just as important as addressing asymmetries in rotational movement, adductors vs. abductors, and muscle restrictions. Addressing these asymmetries can help reduce the chance of injury, but it can also lead to improved running economy which helps improve speed and power.
Reducing imbalances can involve foundational exercises like bridges, core exercises, single leg exercises, and/or stretching.
Book a 90 minute musculoskeletal assessment & exercise plan here.


Individualized Training plans
There are many free training plans available on the internet for free, but none of them are specific to your needs, goals, and lifestyle. An individualized training plan can help you achieve your goals in a more efficient way and reduce the chance of injury. Custom training plans can take into account work and vacation schedules, can target your specific running weakness (i.e. endurance, speed, mental fortitude, etc.), can dial in specific paces during training, and can make small or big adjustments based on how the training cycle is progressing. Customization ensures the highest quality of training plan for your goals.
Book a training consult and receive a customized training plan here.

Finishing a big race is exhilarating; getting there should be fun, challenging, and fulfilling. Don't let a subpar training program prevent you from achieving your goals!


Dr Jessica Klain PT, DPT, COMT, CSCS, OCS, CNPT
Board Certified Orthopedic Clinical Specialist (OCS)
Certified Strength and Conditioning Specialist (CSCS)
Certified Orthopedic Manual Therapist (COMT)
Certified Nutritional Physical Therapist (CNPT)
Certified Vestibular Specialist
Certified Concussion Specialist
Trigger Point Dry Needling Certified, Level 1&2
Certified Yoga Teacher
University of Florida, Doctorate in Physical Therapy (2009)
The Ohio State University, Bachelor of Science in Biology (2006)
Jessica@physioyogaandwellness.com
www.physioyogaandwellness.com
Call/text: 720-295-0060
 

Running With An Injury: When You Should & Shouldn't Keep Going

Injuries are unfortunate. They are also quite common if you are training for a race or participate in regular exercise. Some injuries can be prevented with careful program planning, cross-training, regular body work, proper refueling and nutrition, and well timed rest breaks. But often times, injuries still find a way to interrupt a well laid out plan. This can lead to a difficult decision: do you run and train through the pain? As a physical therapist, marathon runner, and yogi in Denver CO, I've dealt with my own injuries and helped countless clients heal and find their way back into pain-free exercise.

The classic physical therapist response is "it depends" when a client asks if they should rest or to keep training through the pain. Often times it does depend, and the answer is usually complex because running is a repetitive activity; you put one foot in front of the other, over and over and over again! An 8 minute per mile pace results in about 1,400 steps each mile. That number increases to about 1,500 steps each mile at a 10 minute per mile pace. For anyone running regularly or training for a race, those steps add up quickly!
Each runner's stride varies in hundreds of different ways. A few main variations include heel strike vs. forefoot strike, amount of pronation through weight acceptance, degree of hip extension and thoracic rotation, and vertical vs. horizontal center of mass change. These factors can be altered based on shoe wear, terrain, pace, body mechanics, and fatigue. All these puzzles pieces can effect each-other and lead to the possibility of staying injury free, or developing an over-use injury.

Over-use injuries are caused by repetitive strain to a tissue that is unable to withstand the load that is being put on it. Tendons, ligaments, muscles, fascia, and joints are all susceptible to over-use injuries.

Common Running Over-Use Injuries Include

• Patellofemoral pain (aka "runners knee")
• Shin splints
• Peroneal tendonitis
• Achilles tendonitis
• Glute tendonitis
• Plantar Fasciitis
• Low back pain
• Stress fractures
• Pelvic floor dysfunction

• It takes longer than 24 hours to recover from exercise
• The same discomfort/pain occurs at the same distance or time of a run
• You have to take medication to help fall asleep due to discomfort/pain
• There is a nagging tightness that you can't seem to stretch out no matter what
• Swelling occurs after a run or exercise

Get Rid of Your Tightness & Pain with Trigger Point Dry Needling

Trigger Point Dry Needling (TPDN) is a perfect technique to help resolve stubborn muscle tightness and pain. Unlike a deep tissue massage, myofascial release, or acupuncture, TPDN directly targets the restricted tissue causing your pain. It can take as little as 1 visit to resolve your symptoms depending on the duration of your symptoms, the location of your pain, and the specific muscle involved. TPDN can be performed by healthcare professionals including physical therapists, chiropractors, and dentists that have received extra training in the specific techniques of dry needling. In the state of Colorado, dry needling can be performed by a physical therapist without a doctor's prescription.


How does dry needling work?
Dry Needling uses a monofilament needle (similar to an acupuncture needle) that is directly inserted into the dysfunctional muscle tissue. The goal is to mechanically break down the "trigger point", similar to a deep tissue massage, to reduce pain, eliminate restrictions, improve mobility, and encourage improved muscle tissue function.
What does it feel like?
Common sensations include deep pressure, a starburst sensation, and muscle twitching. It is often described as a "hurt so good" feeling.
Why is it called "dry" needling?
Since there is no medication being injection (i.e. "wet" needling) into the muscle trigger point, it is called "dry" needling.
What are the risks?
In general, the risks of dry needling are minimal. Minimal risks include the possibility of mild bruising, soreness for 1-2 days after the session, and nerve irritation. The most serious risk is developing a pneumothorax (collapsed lung). This complication may develop if your provider does not take enough precautions while needling in the lung field. Practitioners that are trained properly and use appropriate dry needling techniques will not cause a pneumothorax.
What are the benefits?
Dry needling is a quick and effective soft tissue technique that helps break the cycle of tightness and pain. Following a session of dry needling, patients are instructed to use heat to help the muscle tissue remodel and heal. Targeted muscle activation exercises can also be provided improve movement patterns and prevent your symptoms from returning.
How do I get scheduled?
Get scheduled today via Physio, Yoga & Wellness online booking calendar
To discuss your case further or to ask a question call or text 720-295-0060 or email Jessica directly Jessica@physioyogaandwellness.com


Dr Jessica Klain PT, DPT, COMT, CSCS, OCS, CNPT
Board Certified Orthopedic Clinical Specialist
Certified Strength and Conditioning Specialist
Certified Orthopedic Manual Therapist
Certified Nutritional Physical Therapist Certified Vestibular Specialist
Trigger Point Dry Needling Certified, Level 1&2
Certified Yoga Teacher
University of Florida, Doctorate in Physical Therapy (2009)
The Ohio State University, Bachelor of Science in Biology (2006)
Jessica@physioyogaandwellness.com
www.physioyogaandwellness.com
Call/text: 720-295-0060

Get Rid of Your Low Back Pain Today!

If you're older than 30, chances are you've experienced low back pain at some point in your life. If you're younger than 30, maybe you've experienced it too. Just because low back pain is an extremely common musculoskeletal pain impairment doesn't mean you have to continue to suffer with the pain. Figuring out what to do about your back pain can be confusing, especially in a large city like Denver, CO with so many providers offering services to treat spine pain. Start feeling better today by implementing these 7 easy things in your life to reduce your low back pain.

1. Work Station Set Up: Sitting at a desk all day, or even just for a few hours, can create a lot of load through your spine. The ideal work station set-up involves sitting in a chair that allows your feet to be flat on the ground with your knees and hips bent to 90deg. You should be able to sit all the way back in your chair with the small of your back supported by the chair or a small pillow. Even with the best work station set-up it is very helpful to stand and/or take a quick walk every hour. Buy my favorite ergonomic and adjustable work chair here.
2. Sleeping Position: Sleep is the ideal time for tissue remodeling and healing; sleeping with good spinal alignment can improve this process. If you are a back sleeper, put 1-2 pillows under your knees to help your pelvis rest in a neutral position and reduce the lordosis of your low back. If you are a side sleeper, try putting 1-2 pillows between your knees to reduce the side bend of your middle and low back. In general, a firmer mattress will help support your body better and allow for better spinal alignment.
3. Gentle Stretches to Reduce Pain: Gently stretching your hips and lumbar paraspinals can greatly reduce pain by decreasing tightness and spasms as well as help "open up" your spinal segments. Stretching can include child's pose, reclined butterfly, single knee or double knee to chest, angry cat, and figure 4 stretch in sitting or laying down.
4. "Core" Activation with Movement: Your Transverse Abdominus is a deep core muscle that works like a girdle when activated. It is attached to each low back spinal segment and helps stabilize the spine with activated properly. To activate this muscle work on gently tightening your stomach muscles by pulling your belly button to the base of your neck; the activation should feel like you're gently pulling up and in. Pilates is a great way to improve your core activation. My favorite Denver Pilates studio is UP Pilates in the Highlands.
5. Proper Lifting Mechanics: When lifting something more than 10 lbs be sure to set yourself up for success. By using good body ergonomics you can reduce injury and/or aggravation of low back symptoms. Key things to remember when lifting something are to engage your core, lift with your legs (i.e. bend at your knees vs. at your spine), keep your hips and shoulders square to avoid rotating, and get help if it is too heavy.
6. Motion is Lotion: Joints, muscles, and spinal discs feel better with regular movement. Taking a 15-20 minute walk during the day is a great way to keep your spine lubricated and moving. Find a walking ground on Denver Meetup.
7. Use Ice or Heat: Ice is a great way to manage and reduce acute pain flare-ups. Heat is a great modality to use when you feel "tight" or "spasms" in your low back or hip muscles. Always use a layer between ice or heat and your skin to avoid frost-bite and burns. Buy my favorite hot/cold pack here.

Managing Tennis Elbow

Tennis elbow is the most common overuse syndrome of the elbow. Only 5% of people suffering from tennis elbow actually relate the injury to tennis! It often occurs due to repetitive upper extremity activities such as computer use, heavy lifting, forceful use of forearm, and repetitive vibration.

EDUCATION
Tennis elbow will resolve with adequate rest and time. Do your best to avoid pain-provoking activities. Minimize work tasks that require deviated wrist positions, forceful gripping, and highly repetitive movements.

STRENGTHENING
Using a light dumbbell or elastic band, position your forearm on a table with your hand off the edge and palm facing the floor, then slightly extend your wrist towards the ceiling and hold for 30-60 seconds for 3 sets daily. Progress by slowly moving your wrist upwards through a 5 second count, and then slowly moving your wrist downwards through another 5 second count; repeat 3 sets of 10 repetitions daily.

STRETCHING
Begin by extending your elbow and turning your palm towards the floor, then use your other hand to push your wrist towards the floor and towards your pinky side simultaneously. Hold for 30-45 seconds and repeat 3 times daily.

MASSAGE
Using your thumb, identify the area of tenderness on the outside of your elbow, apply moderate pressure through this area, and oscillate across the tendon in the direction perpendicular to your forearm. Perform for 5 minutes daily.

BRACING
Position counterforce brace one thumb’s breath below the area of tenderness. Fit should be snug, but comfortable. Use throughout the day during your regular activities.

Brain Gains for Knee Pain

First, consider how long your knee has been bothering you. If the injury occurred recently as opposed to several weeks or months ago, you will better be able to narrow down the source of your discomfort. Overuse injuries to the kneecap are frequent, but a hit to the knee during a fall or sport may result in an ACL or meniscus injury.

CHRONIC KNEE INJURIES
Pain can sometimes develop gradually over time because of overuse, lack of a proper exercise routine, plus a variety of other factors. Some of the more prevalent chronic knee conditions include patellofemoral pain, knee osteoarthritis, and runner's knee.

PATELLOFEMORAL PAIN
For your kneecap to move appropriately inside the groove of your femur, the soft tissues that attach to this joint must be flexible, and the muscles responsible for moving your kneecap must be strong. If certain soft tissues are tight, they may pull your kneecap in a less favorable direction, and if certain muscles are weak, your kneecap may not track properly. Kneecap discomfort is centered on the front of the knee and worsens with prolonged sitting, squatting, and climbing stairs.

KNEE OSTEOARTHRITIS
Discomfort that worsens over time with weight bearing, and stiffness that develops after prolonged sitting or standing are common symptoms of knee OA. Keep in mind that not everyone with radiographic evidence of knee OA is symptomatic, in fact, only 15% of these individuals actually have pain! Exercise stimulates the movement of synovial fluid, which aids in the nourishment of your joint. If weight bearing causes pain, begin with non-weight bearing activities that focus on mobility and strength.

RUNNER'S KNEE
This condition does not only affect runners, in fact, it is a term that describes a variety of conditions that cause discomfort around the front of the knee. Two of the most common causes of runner’s knee include kneecap issues and IT band friction syndrome. Just because someone has flat feet or weak hips does not mean this is the one and only reason they are in pain. Runner's knee can be prevented if you restructure your exercise routine to minimize overtraining, while also integrating a fair dosage of strengthening drills regularly.

START TODAY!
Understandably, your life may be hectic and finding time to exercise everyday may be difficult, however, there are methods you can start implementing today to move more purposefully if you are ready to make a conscious effort to do so. For example, rather than 'plopping' into a chair, sit down gently, engaging your muscles against gravity, or when using the stairs, minimize use of the railing and use your legs for greater propulsion.

Managing Your Low Back Pain

Low back pain is the most frequent musculoskeletal complaint and one of the leading causes of disability. However, don't be too concerned; low back pain might be compared to the common cold of the musculoskeletal system. Like the common cold, there can be a variety of contributing factors. The most effective strategy to handle low back pain is to treat it holistically.

MOVE
That's right. Move. Starting out with some gentle movement can help get the body's muscle and joints ready for the day and clear up that early morning stiffness. It's a good idea to incorporate movements that involve all directions. Think "Motion is Lotion".

STAND
One of the biggest evils contributing to back pain is prolonged sitting, which causes virtually all muscles associated with the hips and legs to maintain a shortened position. Such muscle shortening plays havoc to the back; particularly when one starts to engage in almost any activity. So, it's a good idea to Stand for even a few minutes throughout the day.

HAPPY FEET
There is a saying: "When the foot hits the ground, everything changes." In other words, the stress your feet endure when walking will effect the whole body above it. Do your body - and your back - a favor, and wear good supportive shoes.

UNCROSS THOSE LEGS
Research has shown that repeated cross-legged sitting causes undue stress on the pelvis and the lumbar spine. Eventually, this can cause back pain due to the positional stresses. Sit straight.

MOVE WITH EFFORT
Studies show that, regardless of one's health, moving with some effort (in other words, strength training) has been shown to REDUCE back pain. It is a good idea and highly recommended that one consult with a movement specialist (physical therapist, for example) prior to engaging in Effort Moving in order to avoid unwanted injuries.

How Chronic Ankle Instability Can Affect Your Running

By Caitlin Alexander, PT, DPT, CAFS

Chronic Ankle Instability (CAI) can plague runners with recurrent injuries. It is a condition that can develop after repeated ankle sprains and is characterized by repeated feelings of the outside of the ankle “giving away”. CAI has been shown to possibly even develop before adulthood, in adolescent sports.

Studies show that the biomechanics of those with CAI ware notably different with walking and running (and even standing). Following a lateral ankle sprain, 40% of individuals will go on to develop CAI down the road. The biggest risk factor for developing CAI is a history of lateral ankle sprain. The biggest risk factor for a lateral ankle sprain is ALSO a history of lateral ankle sprain. Why is that?

We know that mechanical strength of damaged ligaments during an ankle sprain can usually heal pretty well, but the sensory fibers that provide proprioception (awareness of the ground and where our foot is) in the joint and ligaments are lost. If an ankle has not healed properly or been rehabilitated properly following an ankle sprain, the risk for developing CAI increases.

The biomechanics of those with CAI 

The research has repeatedly shown that those with CAI present with altered gait mechanics both walking and running. These individuals land with a more inverted foot posture and tend to laterally load their feet more, which can be problematic as this puts them at a higher risk for another lateral ankle sprain. These runners also have higher levels gluteus medius activation, potentially as a proximal neuromuscular strategy to compensate for loading the outside of their feet. Individuals with CAI are also unable to fully pronate the foot and load the big toe and first ray prior to toe-off. Research also shows the benefit of strengthening the peroneus longus muscle, which everts the foot and controls pronation and first ray plantarflexion.

This is why it is critical to see a physical therapist as soon as possible after an ankle sprain to reduce the risk of it progressing to CAI down the road.

Rehabilitation

With CAI, the research is clear about the importance of dynamic balance training, proprioceptive training and strength training, particularly of the gluteus medius and peroneus longus muscles. If you are struggling with chronic ankle instability or have had a history of repeated ankle sprains, it is critical to see a physical therapist who can address your neuromuscular deficits and create a progressive plan to get you back to doing what you love.

References:

DeJong AF, Koldenhoven RM, Hart JM, Hertel J. Gluteus medius dysfunction in females with chronic ankle instability is consistent at different walking speeds. Clin Biomech (Bristol, Avon). 2020 Mar;73:140-148. doi: 10.1016/j.clinbiomech.2020.01.013. Epub 2020 Jan 20. PMID: 31986459.

Donovan L, Hetzel S, Laufenberg CR, McGuine TA. Prevalence and Impact of Chronic Ankle Instability in Adolescent Athletes. Orthop J Sports Med. 2020 Feb 18;8(2):2325967119900962. doi: 10.1177/2325967119900962. PMID: 32118082; PMCID: PMC7029541.

Lin, CI., Houtenbos, S., Lu, YH. et al. The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review. J Foot Ankle Res 14, 41 (2021). https://doi.org/10.1186/s13047-021-00480-w

Lin CI, Khajooei M, Engel T, Nair A, Heikkila M, et al. (2021) The effect of chronic ankle instability on muscle activations in lower extremities. PLOS ONE 16(2): e0247581. https://doi.org/10.1371/journal.pone.0247581

Koldenhoven RM, Feger MA, Fraser JJ, Saliba S, Hertel J. Surface electromyography and plantar pressure during walking in young adults with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1060-70. doi: 10.1007/s00167-016-4015-3. Epub 2016 Feb 8. PMID: 26856315.

Which Running Shoe Is Right for You

By Caitlin Alexander, PT, DPT, CAFS

One of the most common questions we get from our runners is in regard to what kind of running shoe they should wear. This happens to also be the most difficult question to answer straightforward! Running shoes are highly subjective and what works for one person may not necessarily work for another. There are so many different brands and models on the market that it can be a bit overwhelming to know where to start. Below we break down a couple of the important concepts when it comes to running shoe style to help you make the best choice.

Do you need stability or neutral shoes?
Stability and motion-control shoes were historically designed to decrease excessive motion at the foot and ankle, such as excessive pronation. Neutral shoes are lighter, a bit nimbler, and allow the foot and ankle to move more naturally. The most important thing to remember when it comes to running shoes is that shoes do not run, PEOPLE do. When a runner is considering what type of shoe he or she needs, controlling motion may not the best approach. Footwear doesn’t necessarily stop or improve any type of foot motion. And often times, people would rather spend money than do the work it takes to improve their bodies and their feet.

We’ve all been told that pronation is bad, but in reality, pronation is a necessary part of the ankle’s shock absorbing system. The issue arises when that motion is uncontrolled due to poor foot and ankle intrinsic strength. Excessive motion at the foot and ankle can lead to a whole host of issues up the chain including plantar fasciitis, Achilles tendinopathy, knee pain and hip pain. As a physical therapist, my first line of defense is always to train the body to handle the demands of running. It is a much more sustainable, long term approach to healthy running. A stability shoe can be used in the interim to reduce these forces while a runner is working on improving foot and ankle control, but it should not be a permanent, long term solution.

Lots of cushion vs. minimal cushioning. Which is better and why?
This is a hot topic in the footwear industry right now, with the current trend towards highly cushioned shoes with carbon plates and large stack heights. Did you know that your running mechanics change based on your shoe’s stiffness and the material it is made out of? Shoes with lots of cushioning and a large stack height bring our feet further off from the ground, and as a result, our body loses its sense of where the ground is (or its proprioception). This sensory information from our environment is important because it tells the foot how to properly load the body when it hits the ground. With so much material between the foot and the ground, highly cushioned shoes can create a disconnect between the feet and the brain, causing weak feet and issues up the kinetic chain.

We do know that when you run barefoot, you increase your cadence and you have a shorter step length. In shoes, you put greater negative forces through the knee and the hip because you land stiffer. Imagine running on the beach barefoot as the sand moves underneath your feet. Your body naturally stiffens up as a response to that unstable surface. So, is the answer barefoot running? Absolutely not. Yes, our feet are designed to function without the need for shoes or orthotics, but our bodies are not designed to pound miles and miles of pavement and concrete, like we do in our modern world. Unless you’ve been walking around barefoot your whole life, you probably need some protective, shock-absorbing material between your feet and the road.

Another thing to consider is the heel height of traditional running shoes. A higher heel-to-toe drop (the offset between the height of the back and the height of the front of the shoe) shifts the low back into extension and puts the load through the knees. This moves the body towards a more quad-dominant position and makes it harder to engage your glutes (the backside of the hip, a runner’s powerhouse) when running.

I always direct my runners towards a shoe in the middle of the spectrum in terms of stack height, cushioning and heel-to-toe drop, unless they already run in minimalist shoes with no problems. If you’re an urban runner and log most of your miles on hard surfaces like pavement and concrete, it might be worthwhile to have a pair of cushioned shoes in your closet to use occasionally for minimizing the harsh impact of those surfaces. I also recommend my runners rotate through a couple different types of shoes, so they aren’t running in the same shoe every day.

Racing flats vs. everyday trainers.
Racing flats differ from everyday trainers in that they are designed to be lighter, faster and more minimal than the traditional training shoe. A racing flat has enough cushioning for a distance race, but is essentially a stripped down, faster version of a trainer. And racing flats are proven to be faster than trainers. Racing flats are a great compliment to your training for faster efforts like tempos and threshold intervals, especially if you plan to race in your racing flats. They give you a better feel for the ground and do a better job and teaching your foot and ankle how to act as a shock absorber and propulsive force. However, I wouldn’t recommend using them for a majority of your runs because they are more minimal, especially if you primarily run on harder surfaces. If you already have a dependable pair of trainers and are looking for a secondary shoe, a racing flat or slightly lighter, more minimal trainer can be a great compliment to your training.

Does brand really matter?
Prominent biomechanist Benno Nigg published a heavily referenced study about running shoes that found that comfort, above all else, was the best determinant of a shoe’s utility. How well the shoe fits your unique foot and how it feels is more important than any flashy technological advancement. That being said, try on a bunch of different shoes to see what feels and works best for you.

As a PT, I rarely recommend a particular brand of shoe to my runners. Instead, I give them guidelines for the technical aspects they should be looking for in a shoe (level of cushioning, heel-to-toe drop, stack height, midsole stiffness). Be well informed before you walk into a running store and don’t buy into the hottest, flashiest shoe craze on the market.

Is it better to go to a store to try on shoes or can I order a bunch online?
Ideally it is best for you to be able to try different pairs of shoes on if you don’t have a good idea of where to start. Some online retailers will let you return shoes easily if they do not work for you. Some running stores also have lenient return policies that will let you try out the shoe for a bit before deciding to return it or not. Regardless of which outlet you choose, be sure to read all the fine print so you aren’t stuck with a shoe that ends up not working for you!

Other important things to note
Most running injuries are repetitive stress injuries that occur from the same stimulus or load applied to a tissue over and over again. Studies show that we can reduce injury risk by switching up your running shoes regularly. You can give your body a different stimulus by wearing a different shoe now and then which will put the foot in a different position and load different tissues.

When considering switching from one type of shoe to another, depending on how far they are from each other on the spectrum of minimalist-maximalist shoes, allow your body a long period to transition. If you’ve been running in highly cushioned maximalist shoes, do not buy a new pair of neural shoe and start doing all your runs in them. There should be a transition period (anywhere from a couple weeks to a couple months) where you gradually introduce the new shoe to your body and your feet. This method of graded exposure is a much more effective way to get into a different type of shoe without increasing your risk for injury.

The Male Athlete Triad: Part 1

By Evan Culbert, PT, DPT

What is the Male Athlete Triad?
Over the past 30 years, research has developed our understanding of the Female Athlete Triad. More recently, research has shed more light on The Male Athlete Triad, a similar condition affecting men. While awareness about the Female Athlete Triad has grown in the endurance community, many are unfamiliar with The Male Athlete Triad.
Each of these conditions fall under the umbrella of Relative Energy Deficiency in Sport, or RED-S, a broader condition affecting both women and men. These are problems related to prolonged training in an energy deficient state, aka a state of low energy availability in the body.
Imagine the energy your body uses as money. This money is energy availability. For the sake of the metaphor, let’s call this, “energy dollars.” Eat breakfast? That’s a direct deposit of energy dollars into your body’s energy availability checking account. Going for a run? Time to make a withdrawal.
This is how our body works (albeit very oversimplified). You wake up and eat a bagel. Boom, 5 energy dollar deposit – you have energy available and are ready to run. Your run costs you 3 energy dollars. Your body makes physiological adaptations and you become a little faster.
Let’s say after you eat your bagel ($5 deposit), you go for a long run that costs 6 energy dollars and overdraft your checking account. That’s okay, your body can take out an energy dollar from your savings account – energy stored elsewhere in the body. Afterwords, you refuel, and your body builds back stronger. 
But let’s say you don’t refill your accounts. And you do this day after day. Your checking and savings accounts are running dry, you’ve spent all your energy dollars and you go into energy debt. You are training in a state of low energy availability. Let’s step away from this kooky metaphor for a minute to look at a study:
In this study, runners reduced energy intake 50% of daily needs and ran 60 minutes on a treadmill every day for 3 days. This caused a 15% decrease in bone formation. In just 3 days! When we continue training in an energy deficient state, with an empty energy availability bank account, our body shuts down other critical processes in our body because there just aren't the funds for it. We have no resources to direct towards building back bone or recovery because in our low energy availability state, everything we have is going towards training. The longer we train with improper fueling, the more these effects are compounded. This is the root of Relative Energy Deficiency Syndrome, or RED-S, and it can manifest in dysfunction of metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health, and other bodily systems.
The Male and Female Athlete Triad’s each involve 3 interrelated conditions secondary to training in an energy deficient state. The Female Athlete Triad was coined prior to RED-S over 30 years ago. It consists of low energy availability, altered bone mineral density, and menstrual dysfunction. Increased research in recent years on the Male Athlete Triad has furthered our understanding of the condition, and like The Female Athlete Triad it is important to know how to recognize and address it.
What is the Male Athlete Triad?
3 interconnected conditions make up the triad:
1) Low energy availability (EA) – put simply, more energy is going out than coming in. To return to our metaphor, the body is operating without energy dollars in the bank and is paying for activity with credit – other bodily functions are suppressed as the athlete continues to train in an energy deficient state. Low EA can be present with or without disordered eating. 
2) Impaired Bone Health – as illustrated by the study mentioned above, operating in an energy deficit has significant impact on the body’s bone health. Low bone mineral density is present in a bigger proportion of lean-sport athletes like runners, swimmers, jockeys, and cyclists. 
3) Suppression of hormone function – Specifically, the hypothalamic-pituitary gonadal (HPG) function, resulting in decreased testosterone concentrations and decreased sex drive.
It is important to note that the male athlete triad is a continuum. There is no exact threshold value of energy availability that once crossed leads to metabolic changes and dysfunction. Instead, we see a spectrum: on one end we see optimal energy availability, bone health, and hormonal function, and on the other severely low energy availability, osteoporosis/possibly bone stress injuries, and Hypogonadaropic Hypogonadism (negative hormonal changes). These changes happen over time when training with low EA. When caloric intake is not enough to fulfil the cost of training load, athletes begin to go into “energy debt.” Initially, athletes may be able to perform well in a state of low EA, but it is not sustainable as they will continue to move towards the unhealthy end of the spectrum. 
Athletes with or without disordered eating can experience the Male Athlete Triad. 8% of male athletes develop eating disorders, and this number is higher among “leanness sports” like running, swimming, and cycling. Unintentional undereating can also lead to low energy availability. However, it is not always a simple equation of caloric intake equaling energy expended during training to avoid going into energy debt. Oftentimes athletes fail to consider the impact of being a human being and dealing with the daily stressors of life! Life load and the stresses that come along with it can have an impact on our energy availability. Jobs, school, relationships, sleep, stress, quality of food, and difficult life events are all important parts of the equation that demand energy, and are important for any coach, athlete and clinician to remember. 
Male athletes that continue to train with energy debt, aka in an energy deficient state, begin to demonstrate objective changes that indicate long term energy deficiency. This is as a result of not having energy remaining after the cost of exercise for the body’s basic processes, and includes:

• Changes in metabolic hormones (i.e., decreased testosterone)
• Lower resting metabolic rate (RMR) - the body suppresses the energy directed towards basic bodily processes to conserve energy
• Changes in body weight and composition

• Persistent fatigue and lethargy – this one can be tricky. For many endurance athletes, fatigue is a part of training. We all know the feeling of being in the middle of a training block and feeling tired just walking up a flight of stairs. Fatigue is a part of endurance sports. However, concerning signs may include feeling fatigued after appropriate rest days, when expected to be relatively fresh for intense training sessions, or fatigue that carries through tapering.
• Decreased libido and the absence of morning erections
• Decreased beard growth – needing to shave less often
• Negative performance changes in their sport
• Mood changes that are unaccounted for
• Getting sick more often than normal
• Recurring injuries

The Male Athlete Triad: Part 2

By Evan Culbert, PT, DPT

Diagnosis and Management of The Male Athlete Triad
To recap part 1, we know that The Male Athlete Triad is comprised of three interrelated conditions: 
1) Low energy availability (EA): Energy intake < Energy expended. Important bodily functions are suppressed as the athlete continues to train in an energy deficient state. Low EA can be present with or without disordered eating. 
2) Impaired Bone Health: Low bone mineral density, often manifesting in bone stress injuries in athletes.
3) Suppression of hormone function: Specifically, the hypothalamic-pituitary gonadal (HPG) function, resulting in decreased testosterone concentrations and decreased sex drive.
But how do we prevent and identify The Male Athlete Triad in athletes? 
Increased awareness of signs and symptoms among medical professionals, coaches, parents, athletes, and sports organizations is an important step, but early screening and monitoring for RED-S and the Male Athlete Triad must become common practice for at-risk groups.
At-risk groups for developing 1+ components of the triad include “adolescent and young adult male athletes in sports that emphasize a lean physique (lean-sport athletes), especially endurance and weight-class athletes.” Screening of athletes in these sports (distance running, swimming, cycling, wrestling, etc.) should be a part of pre-participation physical exams beginning in middle school. While especially important in middle school – college-aged athletes due to peak bone development happening during this time, it is also important to continue to screen post-collegiate athletes in lean-sports. Formal screening should also happen when an athlete presents with common symptoms of the Triad :

• Persistent fatigue and lethargy – this one can be tricky. For many endurance athletes, fatigue is a part of training. We all know the feeling of being in the middle of a training block and feeling tired just walking up a flight of stairs. Fatigue is a part of endurance sports. However, concerning signs may include feeling fatigued after appropriate rest days, when expected to be relatively fresh for intense training sessions, or fatigue that carries through tapering. 
• Decreased libido and the absence of morning erections 
• Decreased beard growth – needing to shave less often 
• Negative performance changes in their sport 
• Mood changes that are unaccounted for 
• Getting sick more often than normal 
• Recurring injuries 

• Team Physician or sports specific physician
• Sports Dietician
• Mental Health Professional if disordered eating or eating disorder is present. 
• Physical Therapist or Athletic Trainer competent in managing energy deficiency in sport. 
• The Athlete! In youth athletes, parents should be a part of this team as well
• Endocrinologist when hormonal involvement (Hypogonadotropic Hypogonadism) present

5 Signs Your Pain Is Nerve Related Pain

By Caitlin Alexander, PT, DPT, CAFS

One of the most challenging aspects of my job as a sports physical therapist is determining what tissue in the body is the source of a patient’s pain. There are a variety of types of tissue sources of pain and sometimes an injury can cause multiple. Because all muscles, tendons and soft tissues in our body are innervated by nerves, a foot problem could very well be manifesting from a nerve-related problem else where in the body. Nerves run from head to toe so any kink or sensitivity long that nerve route can potentially cause pain (think kinks in a long hose).
Nerve-related pain is a lot more common than most practitioners realize, especially in the athletic population. Probably 20% of injuries I treat in runners, cyclists and triathletes are actually nerve related pains that present as a muscle, tendon or other soft tissue injury.
What is nerve pain?
Nerve (or neurogenic) pain can occur any time a nerve is sensitized. This sensitization can happen at any point along a nerve’s trajectory - from the point where it exits the spinal cord in the spine, and along the the nerve’s route to any of our limbs. Once a nerve is irritated, it can be very sensitive to stretch, compression and even chemical changes (hormones, inflammation from another local tissue) in the body.
Nerve pain can be peripheral (an irritation to the nerve along its route as it goes throughout the body’s limbs), or central (originating from the spine). Central pain can often refer peripherally to various parts of the arms or legs and mimic other orthopedic or musculoskeletal injuries.
So how do you know if your pain is nerve-related pain? Nerve pain can be tricky to diagnose but there are few patterns that are worth pointing out:
1. Your Pain Doesn’t Respond to Traditional Treatment - if a patient comes into my clinic with an injury that failed to resolve with other PT, I always look at the spine or for neurogenic symptoms. If you’re treating a distal injury and it is not responding, always look up the chain! I had a patient come in with lower leg pain that wouldn’t resolve with previous massage, dry needling, or soft tissue work. I looked further up into her hip and low back and found that her pain was actually referral pain along the sciatic and common fibular nerves.
Traditional treatments for musculoskeletal injuries - soft tissue work, stretching, strengthening, dry needling - usually fail to resolve nerve pain if you are being treated peripherally. There is no injured tissue there. Aggressive foam rolling and stretching can also make an irritated nerve more unhappy.
2. Your Pain is Dull, Diffuse, Hard to Pinpoint, or Moves Around - a soft tissue injury like a muscle strain or tendinopathy is usually pretty easy to pin down. Location and pattern of pain are fairly consistent and localized. Nerve pain can be elusive and difficult to pinpoint where it hurts. And palpating the tissue often does not result in that familiar pain (or any pain at all). If you feel pain in a certain area but touching that tissue does not result in that same pain, it’s likely what you are feeling is referred pain - pain referred to that area from a location further away. Nerve pain can be dull, achy, diffuse, sharp, shooting or accompanied by pins and needles.
3. Your Pain is Variable and Doesn’t Relate to Activity Level - when patients come in with nerve-related pain, it is difficult for them to find a pattern of pain. It’s not predictable or consistent with their activity level. Sometimes they have pain from the first step of running, sometimes they don’t. Sometimes it gets better throughout a run, sometimes worse. They might also have pain just sitting on the couch. Sometimes the pain moves from one part of the body to another, anywhere along that nerve’s distribution.
4. You Have Pain at Rest - this is an important one. Random jolts of pain just sitting on the couch or lying down in bed can signal nerve or referred pain. If the nerve pain is a result of nerve entrapment or compression elsewhere, rest will not make it better. Unless you have an acute orthopedic injury, having symptoms at rest can be a red flag for nerve pain.
5. You Get No Answers From Diagnostic Imaging - nerve pain or an irritated nerve does not present itself on MRI or Xray. When a patient doesn’t respond to traditional PT, imaging is often the next route. So it can be disappointing when an MRI or Xray shows no pathology at all. An even more serious consequence is when the imaging shows pathology that isn’t necessarily related to that patient’s pain. I see this WAY too often and it can be even more psychologically damaging.

1. EXAMPLE #1: PATIENT WITH LOW BACK PAIN GETS MRI AND FINDS HE HAS A HERNIATED DISC IN HIS LUMBAR SPINE. HE COMES TO ME AND I FIND OUT THAT HIS PAIN IS ACTUALLY REFERRED PAIN FROM HIS GLUTES - IT CLEARS UP AFTER A FEW SESSIONS.
2. EXAMPLE #2: PATIENT WITH ANTERIOR HIP PAIN GETS MRI TO FIND SHE HAS A LABRAL TEAR IN HER HIP - SHE’S TOLD SHE NEEDS SURGERY TO REPAIR IT. SHE COMES TO SEE ME AND I FIND OUT THAT SHE HAS A FEMORAL NERVE ENTRAPMENT IN THE FRONT OF HER HIP.

Mostability: The Secret To Better Running

By Caitlin Alexander, PT, DPT, CAFS

There's a lot of talk these days on the topic of 'mobility' in terms of sports performance and injury prevention. Runners are always looking for ways to improve performance while simultaneously avoiding those annoying overuse injuries. While mobility is one of the most important aspects of sport, it ties heavily into stability. You can't have one without the other. Mobility without stability and vice versa can lead to subpar performances, poor movement patterns and injuries. This leads us to the topic of MOSTABILITY = mobility + stability. Mostability is a term coined by Dr. Gary Gray of the Gray Institute to blend both elements to complete a desired task (i.e. running).
MOBILITY = the ability of your joints to move through a given range of motion
STABILITY = the ability of the body to maintain postural equilibrium and support joints during movement
There’s a reason why we feel tightness in muscles or joints. Our perception of this tightness is not necessarily related to an overworked muscle and does not always mean that we should stretch it. But rather, the body’s nervous system is telling you that there’s instability in that region. Instability signals the brain and nervous system to put the brakes on because it feels threatened. It does this by borrowing stability from somewhere else to provide a sense of security. This is called compensation. This compensation is the tightness that we feel.
As the Gray Institute says:
“Just as important, but not as obvious is the 'mostability' of the pelvis when our foot hits the ground in running. At ground contact, the posterior-lateral muscles of the hip have a large role in decelerating the motions of the hip, knee, and foot created by gravity and ground reaction force. These muscles need the pelvis to be a stable base from which to generate force, but the pelvis is moving. So again, both stability and mobility are necessary. During running, the one foot will be in the air when a stable yet mobile pelvis is required. How does the pelvis remain stable while it is moving without the connection to the ground? The mass and momentum of the swinging leg, trunk, and arms all contribute to the ability of the pelvis to have 'mostability'.”
So how can you incorporate mostability into your routine? Below is an example of an exercise that we use at BUILD to help runners achieve dynamic single leg strength, stability and mobility at the pelvis.
REVERSE LUNGE with STEPOVER
The hip joint is a dynamic joint that can move in all 3 planes of motion. This exercise is great for runners in that it three dimensionally combines single leg balance, stability and mobility all in one. The focus should be on gaining mobility through the hip joint of the standing leg, so be sure to really open up your trunk, as shown in the video below. Performing the exercise barefoot may be more difficult but will yield better proprioception integration of the foot and ankle. Try it with body weights or with a dumbbell out in front for added trunk and shoulder recruitment.

Stop Sprained Ankles from Ever Happening Again

 https://bottomlineinc.com/blogs/pain-relief-in-motion/stop-sprained-ankles-from-ever-happening-again

This is an article from Bottom Line Inc I wrote regarding the issue of recurrent ankle sprains. The key is that the cause is not at the ankle but the hip. All  attempts to address this issue at the ankle including braces, orthotics and shoes will fail. Learn the true cause of this issue so you never deal with it again. 

Stop a bunion before it begins!

https://bottomlineinc.com/blogs/pain-relief-in-motion/how-to-stop-a-bunion-from-developing

Bunions don't occur arbitrarily. They result from altered force being placed on the first ball of the foot. The process can be stopped and prevented with an understanding of how to stop the forces from being shifted from going to the midline of the foot to over the first ball of the foot. You will be stunned to see that you have absolute control of either stopping the process or preventing it. 

How to properly strengthen the gluteus medius

https://youtu.be/-811etm417k

learn the proper technique to strengthen the gluteus medius. It is responsible for proper balance, stability and running your force line through the midline of the foot.

“The Pain Prescription” Part 1

https://youtu.be/8Llz05PBlSs

PBS Special: "The Pain Prescription" featuring Dr. Mitchell Yass, DPT- 




 

Tiny muscle. Huge impact on RESOLVING PAIN

https://youtu.be/zh_2Os-3wdM

This video explains the role the posterior tibialis plays in supporting the arch and leading to proper weight bearing with all 5 balls of the feet. You will never think that having flat feet or developing bunions is inevitable. Running requires strengthening of this muscle at a much higher level.

Pain at the knee cap from hip region muscle? Really?

https://youtu.be/G4eaHSnBwUg

When you have pain at the knee, the medical establiahment will focus in on the knee as to where the cause of the pain is. This is lunacy. I have shown in more then 99.99% of cases the cause is not where the pain is being experienced. 

This holds true for knee pain amd this is a primary example of understanding the biomechanics behind the idea. If you are a runner you will want to condition yourself to prevent this from happening to you.

recovery ideas

This week I want to take some time to talk about recovery options after runs/ throughout the week or the course of a training cycle. I get asked by a lot of my patients and fellow runners "what do you think of ... rolling, massage guns, dancing counterclockwise 3 times every hour," or whatever other recovery craze they have recently heard and want to try. Here are the ones that I most often recommend. And remember, your recovery is almost more important than your workouts, because if you don't recover, you will run out of steam and break down thus being unable to do any more workouts.

Tier 1: the most bang for your buck
- SLEEP!!!! TAKE A NAP!!!! Note the irony that this won't cost you a penny and gives you the best quality recovery. Our bodies do so much physiologic healing in our sleep. They also take the events of the day and move them from short term storage to long term storage during sleep. Sleeping is easily the best sports performance enhancing drug nobody is talking about. (credit Dr. Matthew Walker, Why We Sleep).
https://www.amazon.com/Why-We-Sleep-Matthew-Walker-audiobook/dp/B0752XRB5F/ref=sr_1_2?crid=1Q7OZZNFMLIRA&keywords=why+we+sleep+book+matthew+walker&qid=1645157445&sprefix=why+we+sleep%2Caps%2C680&sr=8-2

- EAT!!! Your body is just like a car, it needs fuel to work, and if you just ran a good hard workout or a longer than ever run, you need to stop by the gas station and top off the tank. Shoot for something with a good blend of carbs and protein, especially within the first 15-30 minute after a hard workout for best results. There is a bunch of science about "ideal ratios" but sometimes I think we make this too complicated. Get some calories, and make sure there are some carbs and protein. I love a spoonful of white chocolate peanut butter and some chocolate chips. Well, actually like 3-5 spoonfuls!!

Tier 2: go with the (blood) flow
- light heart rate increase with low impact. This is why we suggest the short runs in the week, They help flush out the byproducts from the big runs (the most commonly known of which is lactic acid, but there are so many). Getting a short little spin on a bike, an easy rowing session on the ergometer, an easy run, or a nice hike.

- some sort of flow/ mobility based yoga can help keep joints lubricated and flexible with little strain/ effort for your body.

Tier 3: the more passive stuff (stuff done to you more than by you). Still good, even very good, but never as good as the stuff you do for yourself like above.

- massage: I recommend once/ month if you can afford it in your budget and schedule, especially if committed to a decent 13.1 or longer training block. Recent research shows it may not be doing all the things we once thought, but the number of people who feel recovered after one is irrefutable. There sometimes needs to be room for the "we don't actually know what it is doing, but boy does it work". I believe there is huge power in human touch and that is part of the "healing" that massage can bring.
-- self massage tools such as foam rolling, massage guns, and pressure boots can all fit in this category.

Hot bath (with epsom salts): the power of relaxation and warmth to get vasodilation (wider opening of blood vessels) helps flush out the system. This can be done as often as you like. Once in a while a glass of wine to help calm can be a nice touch.

ice bath: We freeze the heck out of our legs and then what does our body do? Try to warm them back up with an awesome power wash of blood flow that flushes out all those byproducts from muscle use. Ice bath routine: 20 lbs of ice in the tub with cold water deep enough to cover the thighs when sitting with legs out in front of you. Have 2 towels going in the dryer for a bit beforehand, with some tea steeping right before you get in the tub. Try to last for 3-5 minutes. Have nothing to do for at least an hour afterward, but preferably an hour recovery, then bed time. Sit for an hour with towels around legs and sipping on tea. Then head to bed. Should feel quite good for 2-3 weeks, then that heavy leg feeling again, so do this every 4 weeks. Ladies can do it even more often, especially in warmer months as their physiology responds really well to cooling core temperature with this. Do it too often, though, and the effects become a little less dramatic, much like no longer getting scared at the scene in the horror movie that used to get you every time, but now you've become desensitized to it. So I recommend doing this no more than once/ week or two weeks. A cold shower is fine to do more frequently, but this level of cold we want to save for more rare occasions.

So there are some recovery ideas that I have seen evidence for and good results over the last 14 years as a physical therapist. Try some of these ideas in the next few weeks if you have been slacking on your recovery.
 

What to Eat Before, During, and After a Workout

     A regular exercise plan is key to our health and well-being. Whether at-home or at a gym, all adults benefit from exercising for many reasons. According to the American Heart Association, adults should aim for at least 150 minutes per week of moderate-intensity aerobic activity (or 75 minutes per week high-intensity) and at least two days of muscle strengthening activities such as resistance and/or weights. While there may be distractions and interruptions with at-home exercise -- a child needing help, a pet showing affection, the oven timer telling you dinner is done -- the benefits extend well beyond your workout. For those of you committed to a regular exercise routine or looking to increase your activity, it’s important to remember how nutrition plays a role in your performance and recovery.

     Before your next workout, remember these tips for fueling your body adequately before, during, and after exercising. Fuel up with carbohydrates! Making sure your body is fueled and ready for exercise is almost as important as knowing what movements you are doing for your workout. It can be compared to trying to drive a car that has no gasoline… you would not get very far. Our bodies most efficiently use carbohydrates in the form of glycogen for most of our workouts. Ideally, a balanced meal consisting of all three macronutrients -- carbohydrates, proteins, and fat -- should be consumed about two to three hours before exercise. When you get closer to the actual workout itself, the goal should be to consume a small snack about 45 to 60 minutes before exercising. This snack should consist of easy to digest carbs with a small amount of protein. A few examples: rice cakes a piece of fruit, oatmeal, toast with nut butter, a fruit smoothie made with yogurt or milk/milk alternative. If time slips away and you are minutes from the gym and realize you haven’t eaten, a quick granola bar will do the trick! Look for a bar with carbohydrates and protein and try to choose one with less than 10 to 12 grams of added sugar. Being properly fueled beforehand can help you crush a workout.

     Re-fuel your body with protein! Post-workout fuel is needed to help rebuild those muscle fibers that were just broken down during exercise. A balanced post-workout snack or meal should ideally be consumed within 30 to 45 minutes after exercise. If this is not possible, have your next meal within two hours post-workout to achieve the optimal metabolic response to support muscle rebuilding and repair. A post-workout snack or meal should consist of carbohydrates and protein, ideally a three to one ratio of carbs to protein, along with some healthy fats. For example, if a post-workout protein shake has 30 grams of protein you should also aim to also have 90 grams of carbohydrates. This will help to maximize proper reconstruction of muscle fibers required to increase strength and muscle mass. A balanced meal including a protein source paired with adequate carbohydrates and some healthy fats is the perfect way to end a workout and to help refuel, rebuild, and recover.

     Stay hydrated! All cells in our body require water to survive and perform basic functions. The general adult recommendation is 64 fluid ounces of water, or eight cups, throughout the day to stay hydrated. This recommendation does not include losses from exercise, through sweat and increased breathing rates. In addition to your daily intake, you should have another 8 to 12 fluid ounces about 15 minutes before a workout. If your exercise session lasts more than one hour, drink another 12 fluid ounces. Lastly, when your workout is complete, be sure to drink another 8 to 12 ounces of water 10 to 15 minutes later. In general, water is the best form of hydration before, during, and after exercising. An exception is endurance exercise such as long distance running or playing a sport that includes long periods of activity such as soccer. These forms of exercise often require additional carbohydrates and electrolytes in the form of a sports drink that contain sodium, potassium, and chloride. Sports drinks should mainly be consumed during or after exercise, not throughout the day in place of water. Staying hydrated will ensure that the cells in your body are performing optimally and giving you the energy you need for your workouts and busy life!

     Next time you gear up for a workout, be sure to remember these tips: fuel up with carbs, refuel with carbs and protein, and stay hydrated to ensure that your body is at its best when exercising and that it is ready to work again the next day!

How Should You Warm Up for a Run?

As runners, we all know that we should warm up before we head out the door on a run, but many of us are unsure what to do. I've compiled this playlist of some of my favorite dynamic movements for you to choose from for your warm up. I usually try to do 3-5 exercises for 5-10 minutes total before my runs. Keep it simple!