Overcoming Chronic Injury

Subtitle: All I want to do is reach my potential and I'm frustrated as hell

Is there any bigger source of frustration for a runner than injury? Not just any injury, but the kind that persists for way too long - chronic injury? I've had my fair share of them and I can't tell you how maddening it is to be full of motivation and love for this sport and not be able to express it. Perhaps you've experienced this, too?

Right off the bat, if this is you, know that you're not "broken", although I understand it can feel that way. More than likely, load is simply not currently transmitted as evenly as it needs to be through the body. We can address this!

Normally with running related injuries, you notice a pain, take some rest from running, and the body heals. If the pain is severe or suspicious enough, perhaps you wisely consult with a doc. I can't tell you how many folks I've known who've wasted precious time before finally going to see a medical provider.

But, what about the kind of injury that is stubborn as hell and persists for months, maybe even years?

Today I'm speaking to those of you who've been to the doc to rule out medical issues, who've worked through a full course of physical therapy, and have already tried strengthening and stretching and massage and working on your form and building up training very gradually, WHEW!

You may think you've "tried everything", but you haven't. More on this later...

What does efficient gait look like? Do you have access to what you need to do it well?

First, know that to walk or run with maximal efficiency requires access to every joint movement in your body. No joint should be still when we walk or run. If every joint is experiencing movement, then the tissues that cross those joints will experience lengthening and shortening. They will be happy. [Read more here]

In my experience, an injury becomes chronic when you've "worn down" or exhausted the current movement options. When you walk or run, your body has a preferred way of doing it. A most comfortable, energy efficient way. And, you will do it the same way time and time again. This preferred way of getting from point A to point B is based on which joint movements you do and do not have access to. If you have access to a joint movement, then it's an option. In turn, if you lack access to a joint movement, then it cannot be an option for your body to utilize when trying to walk or run.

Where Conventional Approaches Fall Short

Naturally, when we experience a pain, we think we need to address it directly. So, we rub it, stretch it, strengthen it, shockwave it, plasma rich protein it, even surgery (and, sure, sometimes it comes to that). But, GEES. What did that poor area ever do to you?!

If this works, fantastic. Often, however, it's a problem with the thought process, not the 'method'.

As I just said, when we show up to running with limited access to movement in our bodies, then, eventually, the parts that do move are going to be more prone to getting overcooked (think sore, tight, weak, etc.) while that parts that do not move just kick back, don't ever move, and eventually get arthritic. I'm speaking in extremes here, but hopefully you get my point.

So, the Answer is: You Need More Movement Options!

The thought process I've found to work extremely well, thanks to the teachings of Gary Ward, founder of Anatomy in Motion, is to identify the movements to which you lack access and then start experiencing them slowly, mindfully, and regularly to effectively 'put them back into your body'. Then, when you walk or run, your body, now having more options, can spread the load around just a little more evenly.

Creating an Environment for Healing to Occur

To me, it's completely understandable as to why an injury can persist for a long time. It's because the conditions for healing do not yet exist.

If your achilles hurts but your heel bone doesn't move well *when it's on the ground*, then what do you need to do? Learn how to experience better heel movement while your heel is on the ground. For example, the heel bone should 'roll forward, tilt inward, and rotate inward' as the foot flattens and knee bends to absorb shock. If the heel bone does not roll forward, etc, and the foot does not flatten, excessive tension will be experienced by the achilles.

The body is GREAT at healing. If you cut your finger, you know how to create an optimal environment for healing to take place. Clean the wound, put a band-aid on it, and, obviously, stop cutting it!

Same thing with running related injuries. You must create an environment in which healing can occur.

- Identify movements to which you lack access.

- Promote movement where it's lacking.

- Make sure the training/running load is appropriate for where you're at, currently.

- Let your body take care of the rest.

Go walk, go run, now with more movement options. The body will select the most efficient way forward based on what is accessible, no need to think about it. Previously overloaded tissues will now be required to do less as previously unavailable parts step up and actually do something for once ;)

When I think about the people who've "tried everything", I have yet to recall someone who said, "I can access all joint movements in my body and I can make all of the shapes I'm supposed to be able to make". So, if you haven't checked THAT box yet, let's get to work!

If you’re navigating chronic injury, please don't hesitate to contact me. I need you healthy and kicking ass again ASAP!

Should You Work On Your Form ...Or Your Mechanics? (And What's The Difference?)

Both, but prioritize mechanics > form. We good?

Ok, I'll explain.

When most people ask about running form, they're referring to how they look while running. It may be helpful to think of this as "running style."

Many are concerned their form isn't "good" or that they're doing something wrong. They're wondering what they could be doing better. Maybe they're concerned form may be playing a role in regards to injuries they've experienced or wish to avoid. A more advanced runner may wish to improve their efficiency or reduce odds of future injury. A newer runner may just want to make sure they don't look ridiculous.

When it comes to running form, there is a lot of well-intentioned advice out there:

- Optimize your cadence (your strides per minute)

- Make initial contact with a certain part of your foot

- Practice barefoot running / run in minimalist shoes

- "Run tall" and other cues

Essentially, it comes down to, 'run like this, not like that'.

There are even branded running forms out there. Pose Method® + Chi Running®, anyone? The premise is that if you run a certain way, the world will be your oyster.

Some of this can be valuable because it's relatively easy to implement. For example, you'll experience lower peak impact and braking forces if you don't overstride (feet landing too far in front of your body). But, in my experience, this is just a short term gain and doesn’t really address the real issues. Maybe peak impact forces decrease, but total force experienced does not. You're still crashing down to earth with every stride. So, you’ll just shift load to other areas of the body that may or may not be prepared to tolerate it.

To sum up, you may look different while running, but your ability to move is still the same. Huh? Follow along.

To this point in my career, it's been rare that someone has asked me for help in improving their ability to move well. I’m going to call this biomechanics. Maybe it's because they aren't aware such a topic exists. Maybe they don't know there's a difference between running style and mechanics. In any case, in my experience, there is a lot LESS awareness around this topic compared to things like cadence, footstrike, strength training, mobility, foam rolling, and massage guns.

That's a shame, too, because working on your mechanics could just be your ticket to running forever, having greater efficiency, solving mysterious chronic injury cycles, decreasing your risk for medical conditions like osteoarthritis (or any condition where stagnation is the root cause), increased stride power potential, better posture, eliminating abnormal muscle states like tightness or weakness, and all around changing your life for the better.

I hope I didn't oversell it, but, to be honest, I've undersold it. Because, as you may have noticed, I mentioned a few non-running things there that are simply not possible to achieve by running like this, not like that.

Now, you'll still need to train smart, eat well, get your sleep consistently, and call your mom for God's sake, but how well you move - your biomechanics - is a [critical] piece of the larger puzzle.

So, what do I mean by biomechanics? Quite simply, to run well we need to be able to move well. Specifically, we need the ability to access every joint movement in our body. No joint should be motionless when we run. If we have access to every joint movement, then we can access the shapes we need to make with our bodies to move forward feeling light, free, and effortless.

If we cannot access every joint movement, then, sure, we can get from point A to point B, but it will not be as efficient. We will attempt to make the shapes we need to make but we won't be able to make them as well. We will be showing up to gait (walking + running) with less than what we need to have the best experience.

We move as efficiently as possible given what we are able to access in our body. More than likely, however, you currently cannot access every joint movement in your body when you walk and run. Don’t take it personally! ;-)

A common reason is that when we experience trauma, we guard or avoid moving the injured area to allow for healing to take place. Or, maybe it wasn’t a physical trauma. In that case, we may hold tension somewhere subconsciously. This is all a natural part of the healing process. However, often this process can be incomplete. We fail to remind these structures how they are supposed to move in relation to the rest of the body, upright, while weight bearing - just like what happens in gait.

So, if you're reading this, I'm betting you want to improve. You want the A. You don't want to settle for a B- or a running career littered with setbacks and unfulfilled potential.

Wow, in searching for a picture showing ‘efficiency’, I found this. Amazingly, joints should move exactly like the cogs shown in the picture!

On that note, let's talk more about efficiency for a moment.

Efficient: achieving maximum productivity with minimum wasted effort or expense.

I could tell you to strike the ground with a certain part of your foot, run tall with a cadence of 180, think about using your glutes ((??)), and breathe through your nose the whole time while telling me a story, but guess what? That will be way less efficient than if you'd just gone out and run your usual way.

If you're an experienced runner, you've already optimized your gait by taking millions of strides. If you're new to running, merely by practicing the task more - running more - you will become more efficient. Your form will self-select and refine as you take stride after stride, over time.

Yes, some of those form cues WILL change your experience of running. You may load tissues differently. If you're injured, that might even allow you to run with less discomfort. Yay! But, you're just kicking the can down the road. The underlying problem still exists.

Take home point of the day

If you show up to running with a hip that cannot flex well [or insert any joint movement here], then no matter what style of running you adopt, you will always be running with a hip that cannot flex well. THIS is the problem. Not your foot strike. You can run Chi, Pose, backwards, or prancercize (remember that??) and you'll do it all to the best of your ability all with an inability to flex your hip well. You'll get the job done and get from point A to B, but continue to move around your limitations.

What To Do

If you're interested in improving as a runner, there are certain big ticket items you need to address:

- Stability in life, first and foremost

- Train consistently + progressively + enjoy the process

- Lifestyle factors (sleep, nutrition, stressors)

- How well you move

These are all foundational. The broader your foundation, the higher your potential peak. Ignore any of these and you've got holes in the resume with massive improvement potential.

Our sport is literally gait. Walking, running, same thing. If your gait ain't good, running more and getting stronger and sleeping more isn't going to improve it.

As a runner, part of what you signed up for is to be working on how well you move. Here's the basic process:

1. We must identify what joint movements to which you lack access. What's missing?

2. Learn what these movements should look and feel like.

3. Practice the movements daily to put them 'back on the movement map' and make them available during gait.

4. Run naturally, as relaxed as possible, and don't think too much. If you show up to running having access to what you need to do it well, then your body will take care of the rest.

Please contact me to set up a phone call so I can learn more about your situation and discuss how I may be able to help.

In the next post, I'll discuss chronic injury and what the HECK makes it chronic. If you've ever dealt with a frustrating long term injury, you won't want to miss this one!

Problems Vs. Symptoms - Is There a Difference?

Awareness. Man, that is a valuable thing.

Imagine if you had no awareness that there was a 100% chance for an ice storm to hit when you were halfway into a long run. Might you change your plans if you had this information?

Now let's talk chronic running-related injuries. These are those injuries that "just started for no reason". Or, maybe they coincided with an increase in training load or some other variable. But, consider if the injury is only on one side, you can probably rule out training as the root cause.

Let's up the ante and talk about the especially chronic ones. The kind that linger for more than a week, 6 weeks, 6 months, even years - despite doing all the things like rest, physical therapy, new or different shoes, cross training, injections, braces, compression sleeves, orthotics/shoe inserts, foam rolling, stretching, massage, strengthening... you get my point.

The annoying, frustrating symptom that you are experiencing is certainly providing awareness alright. You're acutely aware of the symptomatic area - it hurts!

But, here's the question: is the symptom located where the problem is located? The problem is the underlying cause of the symptom. Which would you like to address?

If you keep hitting your thumb with a hammer, do you want to address the symptom (and continue to hit your thumb) or address the cause?

It's a pretty clear choice, isn't it? But, with running related injuries determining the problem may not be as obvious.

In my practice, I rely heavily on the teachings of Gary Ward of Anatomy in Motion. He created something called the Flow Motion Model® that details the journey each bone and joint should experience during gait.

So, armed with the knowledge of what movement each bone and joint should be experiencing, we can simply check to see if they are or are not actually able to move in that way.

Personally, I've found time and time again that where the symptom is, the problem is NOT.

Here's a common and personal example:

I suffered a severe right ankle sprain when I was 15. After a few weeks, I was back running. No biggie.

For 20 years I was blissfully unaware that my ankle wasn't moving as well as it should be. And, I was also not aware that the rest of my body wasn't moving on top of that foot as well as it could be. I had nothing calling my attention to this underlying problem.

Then, at around age 35, I developed some knee pain that simply would not go away. It didn't respond well to rest (when I resumed running, the pain would return), strength training, nor any of the stuff listed above, including a course of PT. Plus, I wasn't interested in a band-aid solution.

A colleague performed an assessment and it started with a detailed history. What's happened to me in terms of traumatic injury or surgery? How did we get here?

- cut to right wrist age 5

- head impact w/ 6 stitches age 11

- right ankle sprain age 15

- inguinal hernia surgery age 21

That was as much as I could remember. Fortunately, not much else had happened.

As part of a thorough evaluation, he checked these areas to assess how they were moving. Sure enough, my ability to move that right ankle (the talus and calcaneous, specifically) was limited. Therefore, my ability to move my entire right leg was not up to par.

You know that thing where people say "it's all connected"? Here's how:

My talus bone was not able to move through it's ranges of motion. The talus bone sits directly beneath the shin bone and on top of your heel bone. So, the talus bone will directly influence the movement of the shin bone. The shin bone is half of your knee joint. So, the movement of your shin bone is extremely relevant to the movement of your knee. Again, the shin bone IS (half of) your knee! (And you can trace connections like this this directly up to your skull, if you like.)

Although I was able to cope with the limited ankle movement for quite a while - 20 years! - my body was telling me that time was up. The knee symptom was a yellow light on the dashboard that read: "you aren't moving well enough, please investigate."

Within a few days of practicing my assigned movements, the knee pain, which had annoyed me for over a year at that point, simply dried up, disappeared, and has never returned.

Remember that it takes access to EVERY joint movement in your body to be the ultimate efficient runner. So, if you've got an annoying chronic running related pain and have already seen a medical provider, consider that symptomatic spots scream for attention and they usually get it. Whereas there are areas of your body which are kicking back, hanging out, not moving, and thus, NOT drawing your attention. Let's identify and bring awareness to your problems - in this case, the areas of the body which aren't moving and encourage them to move.

One more thing...

Don't have any current symptoms? Feeling great? That is awesome. Does it mean you don't have any 'problems' as defined here? Hmm. Could it be valuable to assess the body to check for areas that don't move well? For 20 years I had a problem, but no symptom. Actually, I did have a symptom, but it was subtle - reduced efficiency. I don't know about you, but I’d prefer more efficiency, more ease of movement, and like my odds better if everything is moving as it should.

Please don't hesitate to contact me today to discuss your unique situation!

One Weird Trick to Try After a Fall (or very stressful emotional experience)

If you've been running long enough, it's likely you've experienced a fall …or eighteen. It happens! Most of the time, these types of falls produce minor injuries and simply shake us up. These can still be consequential.

At the moment of the fall, we’ll often brace for impact by tightening the diaphragm (think: 'hold your breath') to help provide extra stability to our spine. This a great thing! But, the diaphragm can get 'stuck' in this state. This is a problem because with a tense diaphragm, we can’t breathe efficiently. Structurally, this means we can’t stabilize our spine efficiently by building proper amounts of intra-abdominal pressure. If we can’t build intra-abdominal pressure well, the rest of our body must compensate for this by tightening up.

The feedback I’ll get from clients before a session sounds like this: "My body feels like crap. This hurts and that hurts. I feel like I aged 30 years. I’m not sure why!"

Invariably, I learn that they’ve either experienced a very stressful event or were shaken up (physically or emotionally).

Here’s a short sequence that will calm the nervous system, improve the efficiency of your breathing, and help you feel better more quickly

Let’s do a before and after assessment so you can feel an immediate difference.

1. Lie on your back with your legs up in the air, knees bent 90º. Now move your feet just a few inches farther out away from the body. How effortful, on a scale of 1-10 (1 is extremely easy), is it to hold your legs in that position?

2. Remain lying on your back, knees bent, feet flat. Using your fingers like little mallets, tap your breastbone for 30-45sec, then breathe and expand 360° for 3+ minutes. Think, "In-2-3-Out-2-3-4-5-6.” Slower on the exhale than the inhale.

3. Do Floor Cog w Arm Reaches for 8 slow, mindful reps

- Pelvis rolls toward head, arms spiral internally and reach through ceiling. Skull contact point naturally slides toward body / head tilts back. Notice this shape correlates with exhaling?

- Pelvis rolls toward feet, arms spiral externally and reach through wall. Skull contact point slides away from body. (Neck feels flatter, chin and chest move closer together). Notice this shape correlates with inhaling?

Note: there are other useful movements to explore here, but we’re keeping it simple and effective. One idea is to gently, but progressively, as tolerated, load the injured area which will help remind the body it’s safe to, say, bear weight again.

4. REPEAT step 1. Re-assess. Lie on your back with your legs up in the air, knees bent 90º. Now move your feet just a few inches farther out away from the body. How effortful, on a scale of 1-10 (1 is extremely easy), is it to hold your legs in that position? Did the number change?

Do the sequence (breastbone taps --> breathing --> floor cogs) a couple of times per day for several days, ideally prior to walking or running.

If you try this, I'd love to know about your experience in the comments below. Of course, I also hope you don't experience a fall any time soon!

Client Experience: Andrew Baer

Andrew receives the baton in the 4x 400m at the Penn Relays in 2022

In recent posts, I've discussed needing access to every joint movement in your body, why most running injuries don't generally occur on both legs at the same time (despite presumably running with both legs), and why strength training is unlikely to address the root cause of your injury. While I hope you've found these musings interesting and useful, I'm sure you may be wondering what this all looks like in practice.

Meet my amazing client, Andrew Baer, age 70, sprinter, middle distance, and ultra runner from Rhode Island. After reading a few of these posts, he wanted to share his experience of working with me so you can better understand what it's like to work on your biomechanics and improve as a result.

Here's Andrew:

"In the late summer of 2021 I was training for the Baystate Marathon. I hadn't raced in two years, due to injury and the pandemic and was excited to toe-the-line! I was working with a new coach, John Goldthorp, and training was going well, until one morning I felt a sharp pain in my left hamstring while doing strides.

I stopped my workout and made an appointment with my physical therapist, a friend and runner - the best PT in the area. He did range-of-motion and strength testing, massaged my hamstring, and gave me several exercises. He diagnosed the problem as a strain in the aponeurosis, a tissue that connects muscles to bone. I took a few days off, had several PT massage appointments, did my PT exercises and eased back into training.

Five weeks before the Baystate Marathon I ran the Surftown Half as a prep race. Well, ...I started to run, but got about four miles in and felt a pain in my left hamstring. Damn!

I emailed John - help! John asked that I send him some current pictures and videos. He sent clear instructions for 'gait assessment videos' and 'postural assessment photos'. My son took the videos and photos and John and I made an appointment for a Zoom call.

Prior to our Zoom call John sent me back my photos marked up with red lines showing an imbalance in my posture / gait. Basically, my hips were not moving correctly left to right, evidenced by John's analysis and easy to see when looking at his marked up photos. Somehow this lack of movement in my hips created a strain in the left hamstring when I ran, especially when I sped up (e.g. strides during my training run, and an acceleration down hill during the half-marathon).

John recommended exercises, watched me do them on Zoom and emailed two videos.

1)Weight Bearing 3D Pronation, left foot forward with written instructions breaking the exercise into three parts: Manage the mass, Drift mass sideways, and Rotation.

2) Left Suspension w/ Right Arm Reach. (see videos below)

I did the exercises twice a day and resumed training, cautiously at first. Two weeks before Baystate I ran a long training run and felt good and the next week I knocked out some 800s on the track. No problem - ready to go.

The Baystate Marathon was a success! I was overjoyed to line up in the corals and feel the excitement and camaraderie of a race! My time wasn't quite what I'd hoped for (is it ever?), but I qualified for both the Boston and New York Marathons. I was back!"

Thank you, Andrew, for sharing your experience! If you would like help overcoming a frustrating injury and you've already been evaluated by a medical provider, please don't hesitate to contact me.

PS: If by chance you're reading this and thinking, 'Hey, I've got an upper hamstring injury, will these moves work for me?' The answer is, maybe, or maybe not. These were created and customized for Andrew's needs in that moment. I don't prescribe exercises based on symptoms. Just because you have a hamstring symptom doesn't mean you get 'X' movement. We need to identify the movements you cannot access and then begin the process of experiencing them regularly.

Should I Train By Pace? Heart Rate? Power? Perceived Effort/Feel?

Oh, great question, thanks for asking!

It's a great question because I rarely get asked this. Seems like most runners default to training by pace. It's easy to understand, and, thanks to GPS watches, easy to measure. Some ask about heart rate and only a few about power.

All of these can potentially be useful at times and easy to learn to use, but none are as accurate and versatile as listening closely to your body's cues and monitoring your perception of effort.

Training by perceived effort (from here on called feel because it's only four letters) will very rarely let you down, but it is a skill which takes time and practice to develop. Let me be clear: this is possibly the most important skill you will ever develop as a runner.

Consider the following scenario:

You're tired from a bunch of life commitments, it's unseasonably warm and windy on an early spring day, and you're diligently training for Boston so you head out for the planned hilly 5 mile threshold run. Based on recent race results, your 'threshold pace' is about 7:10 per mile. Do you:

Shoot for 7:10s?

• What about the stress you're bringing to the session?

• What about the heat to which you're most definitely NOT acclimated?

• Will you run the same pace uphill and downhill or try to average it out to hit the 7:10 target pace?

• How about the wind? How will you account for that? Push harder into the wind? Relax with the tailwind?

Hmm, ok, maybe 7:20s since you're taking all of those factors into account?

With all of that going on, is it even possible for this session to end successfully??

Or...

Understand that “threshold” is an effort level. It's about the effort you'd feel if you had to run a race that lasts between 60 and 90 minutes. Ok, cool, so maybe just sense into that effort level, and hold it for 5 miles. Let the pace be what it will be. Let the heart rate be what it will be. Let the expectations go and just nail that effort.

"Nail the effort, nail the workout."

Despite programming my clients' sessions in terms of feel (e.g. run 5x 5 min @ today's perceived 1 hr race effort), the habit of training by pace is so ingrained that if a workout doesn't meet pace expectations, then it is often judged a 'bad' or failed workout. I gently remind them that nowhere on their schedule did it say to run x:xx pace. If you nailed the prescribed effort, you nailed the workout - regardless of pace. Your body got the training stimulus we needed. That was the goal.

On the other hand, in our striving culture, many of us set out to beat the planned workout paces. We tend to consider a session to be a success if we 'beat' the prescribed pace. But is this true?

I mean, hell yeah, if there's a medal given out at the end of the workout for the runner who races the workout! Shout out to all the workout heroes out there (obviously very kidding).

Running by feel will lead you to have success and build training momentum because you'll be less likely to force things when conditions are less than ideal and less likely to overcook workouts.

I hate to state the obvious, but, um, we're not machines. Running by feel takes into account your internal and external conditions in real time, allows you to continuously make subtle adjustments, and nail the correct effort. When you're running uphill, your pace will slow (and you'll be at peace with this). When running into the wind, your pace will slow (permission to still curse out loud).

If you think about it, running by pace is stressful and constraining. If you don't hit the pace - too fast or too slow - it's a miss. Running by feel allows you the freedom to run faster on days when you feel amazing, and slower on days when you don't.

We run for fun, right? Even if your livelihood depends on your running performance, you still need to enjoy it or you're not gonna reach your potential. So, consider training by feel. I think you'll find you get even more enjoyment out of this incredible sport.

What's been your experience? Have you trained by pace? Heart rate? Power? Feel? What's worked the best for you?

There are great resources out there if you're interested in further reading. My favorite is RUN: the Mind-Body Method of Running by Feel by Matt Fitzgerald

Why Strength Training (or Stretching) Isn't Likely to Address the *Root Cause* of Your Chronic Injury

Show of hands, please.

Have you been told or taught that to overcome an injury you needed to strengthen some part of your body or just generally get stronger? How about that you need to regularly stretch certain areas because they're prone to being tight?

I know my hand is up. When I began my career, I viewed strength training as a cure-all. If runners would just strength train consistently, they'd have no issues!

In 2023, STILL, the conventional approach in the fitness and rehab world is to identify areas that are weak, then strengthen them or identify areas that are tight, then stretch/release them. I mean, it kinda makes sense, right?

If you think muscles are the be-all and end-all in training, then what else are you going to do if not treat / work on your muscles?

Credit to Gary Ward of Anatomy in Motion, here's the paradigm shift: In gait (walking and running), "joints act; muscles react" and "muscles lengthen BEFORE they contract.”

This means that your bones move FIRST. Your muscles are set up to initially lengthen to allow for the movement of your bones, then, like a trampoline, contract to propel the bones in the other direction.

Here's an example:

When you land, your knee bends to help you absorb shock. The lower quads (muscles that cross the front of your knee) lengthen to allow the knee to bend. At a certain point, the quads lengthen to a point when they become stimulated (via their stretch reflex) to shorten, which causes the knee to straighten.

Bones move --> muscles lengthen to accommodate the movement.

Muscles lengthen to a point --> then contract to push bones back the other way.

Load --> explode!

Cool! Now what?

Well, the question then becomes, "are your bones able to access the movements they're designed to access?" Because, if they are, the muscles will get the experience they're meant to experience.

If you have chronically tight calves or hips, achy knees, chronic plantar fasciosis, high hamstring tendinopathy (or most other running related musculoskeletal issues), then it's unlikely the bones to which those muscles are attached are experiencing efficient movement.

By focusing on the muscles, you will NOT affect/improve the movement of your bones. Therefore, when you're out there walking and running, your muscles will not 'load and explode'; rather they will continue to get the experience they've always gotten. Thus, you will continue to battle tightness, weakness, and inefficiency no matter how strong and flexible you become.

Instead, let's focus on improving the movement of your bones. Invite them to experience their optimal motion. When they do, your muscles will lengthen and shorten appropriately with every stride you take. Your stride will feel more free, light, and effortless. Aches and pains will evaporate as pressure is more evenly distributed through the system.

So how does strength training and stretching fit in?

My take on strength training has greatly evolved over the years and I hope yours will, too. Perhaps it will continue to do so, but for now it's important to understand that strength training helps us, as runners, to be more resilient. That is, we can handle more stress. This is why strength training isn't a 'bad' solution if you're dealing with injury, but it's not the first tool I reach for.

It also promotes better performance by improving our coordination, our potential to produce power, and hormone profile (e.g., testosterone increases).

So, keep strength training! But, don't expect strength training to address the underlying reason for abnormal muscle issues like tightness or weakness.

While there may be a time and place for the ol’ ‘stretch and hold’, the most valuable type of stretching is called dynamic stretching and it’s great for doing right before running or working out. The lunge matrix or a yoga flow are great examples.

A final example:

Several years ago I was told my glutes were weak.

I scratched my head. Well, dang. Earlier THAT DAY I had front squatted 260lbs with, by all measures, great form. At the time I was really into doing barbell hip thrusts - literally a glute exercise - and could lift 500lbs. And, let's just say it, I didn't exactly have a pancake butt!

So, WTF?

One can have strong muscles but not use them to their potential while running. As we discussed above, if the bones don't move in a way that gives the muscles a role to play, the muscles won't play their role.

If while running my hip doesn't experience the movement it's supposed to (flexion, for example), then glute, in the sagittal plane, will not lengthen sufficiently to cause a powerful contraction.

The solution for me was not to add more strength training, but rather to learn how to access a better hip flexion while walking and running.

Your head might be spinning at this point and that's completely normal! It took me a while to fully understand this perspective and, as I said, this is not currently the conventional way of thinking. But, hopefully one day it will be.

Please don't hesitate to reach out if you have questions or would like to chat further!

Is the Injury On One Side of the Body or Both?

When you've sustained a running-related injury --not the traumatic event kind (like an ankle sprain), but the kind that just 'appears' for no obvious reason-- is it typically on one side of the body or both sides?

I ask because, if you stop to think about it, probably 9 times out of 10 it's only one side that is injured.

Yet, how do most folks explain their symptoms?

- Bad shoes

- New training variable (hills, speed, distance, terrain...)

- Weakness / not enough strength training

- Tightness / not enough stretching / yoga

- Didn't rest enough / poor recovery

- Forgot to foam roll / meditate / psyche up before running

- Slept weird

- Wore the wrong color socks (might this be it?!)

I'm sure you can think of a few more!

Thing is, we run with both legs. Both feet are wearing the shoes, running the hills, the speed, the distance, yet the injury is only on one side. I think we need another explanation. Do you agree?

In my experience, biomechanics is likely where the answer lies.

Remember, we need access to all joint movements if we wish to enjoy maximally efficient running. If a joint cannot access its normal range of motion, your clever body will still find a way to get you from point A to point B. It will rely more on the joints to which you DO have access.

Could there be a benefit to injury?

As frustrating as injury is, you can thank that annoying injury for alerting you to the fact that there is a problem somewhere. But, don't be fooled into thinking the symptomatic spot is the root problem.

Problems and symptoms are very different. The symptom is where it hurts. You'll have a lot of awareness there, obviously. The 'problem,’ however, is likely to be a movement in which you lack awareness because you are unable to access it. If you've never rotated your pelvis well, how would you know what a 'well rotating pelvis' feels like?

The solution, then, is to first become aware of this inaccessible movement and then to experience it on a regular basis so that it feels natural again. (Hint: I can help you with this!) So, indeed, injury is an invitation to become more aware and improve.

Why would you be missing access to a movement??

We all have unique histories and experiences - some of which have caused us to delete certain movements as safe options.

- Sprains, falls, impacts, surgeries, pregnancy, accidents, broken bones, whiplashes, concussions, (the list is endless) are all "structural" examples of reasons why you may have deleted a movement.

- Powerful emotional experiences and high stress levels can cause us to subconsciously hold tension in our body.

- Learned behaviors like holding a certain posture (much love, all you dance/ballet friends) or following movement rules ("keep your shoulders down and back" or "never allow your knee to push beyond your toes") actually limit our movement potential.

Now that we've ruled out causative factors like what time you went to the bathroom in the middle of the night, forgetting to do your mini-band glute strength routine, and others, I hope this discussion has increased your awareness to the possibilities that exist around one-sided injuries. Each little part of the body must play its role, no more and no less.

In the next post we'll discuss exactly why strength training, which is presented as a common solution to overcome many running injuries, is unlikely to address the *root cause.*

For now, if you're wondering if inefficient biomechanics may be contributing to your current situation, please don't hesitate to contact me!

What Does It Take To Be A Maximally Efficient Runner? (aka "I want to feel awesome and have minimal risk of injury.")

ef·fi·cient /əˈfiSHənt/ adjective: (especially of a system or machine) achieving maximum productivity with minimum wasted effort or expense.

So, what does it take?

Strong glutes?

Flexible calves?

High mileage?

Certainly adequate strength and flexibility are helpful athletic traits, though running doesn't require as much strength or flexibility compared with, say, gymnastics. And, if you practice anything a lot, you become more economical so running all the miles surely does make a big difference. Just look at your training paces after a year of consistent training. You got faster and were able to run farther, right?

As runners, it's important to be efficient so that we don't waste energy, but also, critically, so that excessive stress does not accumulate in any one area of the body leading us to injury. If all parts of our body are participating optimally, no one area will be overused or underused.

So, what does it take to be a “maximally efficient runner?"

In a phrase, "access to every joint movement in your body.”

Um, ok, wow, what? That sounds like a lot.

During the time it takes for you to complete one stride cycle (say, right foot initial contact --> left foot --> right foot initial contact), every single joint in your body *should* experience a complete journey from one end of their range to the other, and back.

For example, your [lumbar and thoracic] spine will rotate right as your right leg swings forward and rotate left as your left leg swings forward. Back and forth, to the right and to the left, every stride.

That's one plane of motion. There are three.

How about your hip? The hip flexes and extends, abducts and adducts, and rotates internally and externally.

That's one joint.

This is happening throughout your whole body. We have 33 joints in each foot. Do all of those move well? Hmm. This is really adding up!

Don't get me wrong. The absolutely amazing thing about our bodies is that we can get the job done. We can get from point A to B. We can also survive on a diet of Haribo gummi bears for a while, too.

That is, we can't cope forever without paying a price. Eventually that hip that never extends might lead to an annoying low back or upper hamstring pain as those areas take on extra work. The hip that can't externally rotate well might produce piriformis symptoms.

Yeah. So then the question becomes, "do you have access to every joint movement in your body?"

Don't Know What You Don't Know

I can guarantee you have areas of your body which are not moving and you have no idea they exist. Often what draws our attention is the area which is moving too much. The tight calf, the achy knee, the sore hamstring - which all represent symptoms of inefficient movement - aren't the actual problem.

We need to identify the areas which aren't participating and invite them to join in on the action. Would you like help with this process? Contact me today!

Bonus form tip:

There are exactly ZERO areas of the body that should be still or holding tension while you run. So, get out there and run nice and relaxed. Scan your body for tension. Three of my favorite areas to check are: the jaw, the shoulders, and the feet. If you notice any tension, see if you can let it go.

Summer Hydration Tips With Dr. Brandon Eck

When it comes to hydration and hot weather, as French author Voltaire says, "common sense is not so common". Special thanks to Dr. Brandon Eck, sports medicine (non-op) physician at Premier Orthopaedics in Havertown and Chadds Ford, Pennsylvaniafor these excellent tips and helpful reminders (and for reviving my blog)!

Summer is upon us! Here we are counting down to many of this years best races! 5k’s to marathons, even long trail runs during these dog days of summer. 

You pack you clothes and shoes, charge your GPS watch, maybe some sunblock and extra socks (just in case) and you’re about to head out the door… that’s when you realize you almost forgot your water bottle! 

Usually the last thing on our minds, we mindlessly brush off the notion or grab that empty water bottle. Thoughts of, “oh they’ll have water stations”, or “I’ll grab a bottle at the start line.” we oft forget that the best assurance we have to complete a task is preparedness! And nothing can lead you to falter faster than nutrition. Science tells us that even a 2% reduction in body weight, from water loss, can have a noticeable difference in both physical and mental performance (1).

How much do I need to drink?

There isn’t a one-size-fits-all volume when it comes to hydration. In general, your fluid intake should depend on your sweat rate, or the amount of fluid you’re losing through sweat while exerting energy. Sweat rates vary depending on body size, exercise intensity, and environmental conditions. For example, a smaller person running 7-minute miles in mild conditions might suffice with a half liter but a larger person who is running 9-minute miles in 80-degree heat might need 2-3 liters of water an hour.

How do I know I am drinking enough?

For starters, your urine color could tell you. Clear to pale yellow color means you are well hydrated, while a darker or concentrated yellow is sign of dehydration. However, our bodies can be foolish; often our feeling of thirst will lag behind our needs and even disappear before we are fully hydrated! 

To be smart, follow these simple tips to help you on those long runs and race days:

Start hydrating 1-2 hours prior to your run. 

Small sips of water over longer periods are better than drinking large amounts in a short period. (Take this into consideration when planning, even carry bottles to sip throughout a race without needing to rely on the aid stations where we tend to want to chug.)

Start sipping before your thirsty on runs longer than 1 hour (30-40 minutes in).

30-60g of carbs is recommended for every hour of running = one 16oz Gatorade® (or alternative of choice!). (2)

Don’t eat or drink anything you didn’t or wouldn’t eat during training on race day!

Food options other than fruit or candy include GU®, Hammer®, Stinger® and Clif® and are all great options.

If you have a sensitive stomach or are a picky eater, try out foods during training runs to ensure you feel good while consuming them. 

If you're peeing clear before a race, limit your intake to jut sips as you near run/race time. Over-hydration can lead to the need to urinate during the race!

Avoid alcoholic beverages in the days prior to the race as they can increase urine output and delay optimal rehydration. 

Check the weather and plan ahead! Extra layers, extra bottles, sun exposure, even cold conditions all affect how much water and nutrition you need to not only stay warm/cool but propel you to the finish!

Happy and Fast Racing!!!!!!!!!!!!!!

Thank you Dr. Eck for the useful tips and I'll remind everyone that you're an "n=1" which means you'll need to figure out some of this on your own through some trial and error. As Dr. Eck mentions above, there are quite a few variables that come into play. Use these tips as a starting point, adjust based on how you feel, combine with a more conservative mindset, and you'll consistently feel much better in hot conditions.

1 http://www.sportscardiologybc.org/the-effects-of-hydration-on-athletic-performance/

2 https://www.gssiweb.org/docs/CanadaEnglishLibraries/sport-specific-materials/practical-sports-nutrition-maintaining-hydration-and-proper-fueling.pdf?sfvrsn=6

How You Will Crush a Windy Race

You’ve trained really hard, you’re in great shape with a chance to run your best time or a Boston Qualifier, but there’s a giant wind situation predicted. How do you adjust?

First, throw a pity party, stomp your feet, maybe cry a little. Get it out. Things won’t be “perfect”.  Boo!!!! Womp, womp, womp!

Got it out? Good!

Ready to proceed to crush it anyway? GREAT.

First, forget about your time goal (but don’t toss it completely). Here’s what I want to know: what will a successful race look like to you?

Write that down. Maybe it's:

“The last 4 miles are my strongest of the whole race.” 

or

“I couldn’t have raced any smarter or pushed myself any harder.”

Cool, those are both good. Anything else? No rules here, but try to envision yourself at the finish totally satisfied. How’d you get there?

Next, it’s important to realize that people DO RUN WELL WHEN IT'S WINDY (or rainy or cold or hot). How?

They don’t view it as a negative!

Wind just IS. It’s a variable that you need to account for, but it’s not a negative or something that you need to overcome. And it’s definitely not something that you “fight”. Why? Because it will always win.

Here are 3 things you CAN DO to run well during a windy race: 

EVEN EFFORT

Manage your effort intelligently no matter what the conditions are. In a distance race, especially a marathon, this means running a very even, consistent effort. Your pace may fluctuate, but you’ll be most efficient and have more energy late in the race if you avoid fluctuations in energy expenditure. 

Adopting this strategy means you need to stay alert and react to what’s happening. So, if you turn a corner and smack into a headwind, you need to sense into your steady, consistent effort and simply maintain. A heart rate monitor can confirm your effort remains steady, but ideally this is something you can feel and will have honed through training.

I always remind myself to 'relax into the wind' as the temptation to fight or push into it is often strong.

DRAFTING

Tactically, if at all possible, a great strategy is to tuck in and use other racers to shield yourself from the wind. Known as drafting, be advised that sometimes the ideal position may be to the side of another runner. 

Cyclists know what I'm talking about - this is called an echelon formation.

The protection you’d get from pack of runners is always more effective - and more ‘fair’ - than a single runner. Bonus feature: running in a group can actually give you energy as you’re all working together towards a common goal.

MINDSET

On a course like Philly that has a lot of turns I still think you can run a good time despite the wind, BUT that is not something you can directly control.

So let's not focus on time. Wind is going to affect your splits - some will be faster, some slower. And wind *may* impact your overall time, but remember that isn't what will make the day a success or not. Right? We talked about this earlier!

What you can control is your mental approach by remaining calm, consistent, and cheering yourself on. Focus on your ability to make good decisions in the moment so you can set yourself up for a strong finish and a satisfying result regardless of time.

Reframe your thoughts around wind. It is what you think it is. 

You think it sucks? You think you’ll run slow because of it? You hate it? You’re right.

Or will you be one of the athletes who crushes it despite the wind? Your call!

PS: For more marathon mindset tips, check out THIS article I wrote for Philly.com!