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Lack of Internal Hip Rotation Relates to Low Back & Hip Pain

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Improving internal hip rotation is important for a variety of reasons including:

  • It allows us to go into a deep squat position safely

  • Key contributor to knee and low back pain

  • Poor movement for rotation sport athletes like baseball or even golf

  • For runners, it doesn’t allow the athlete to extend the hip to engage the glute.

Hip IR should be tested in two positions, because different structures can limit your range of motion depending on whether the hip is extended or flexed. The second test is actually a mobilization for improving hip IR if and when progressed properly.

Testing Seated Internal Hip Rotation

Sit at the end of a table, with your knees bent over the side, and hold onto the table itself.

Now internally rotate the hip, without abducting or side bending, which is a sign of compensating with the lower back.

Generally speaking 35 degrees is good in the general fitness population and 40-45 degrees in competitive athletes.

A quick check to see if you may simply have a "lazy" side if one leg has better hip IR than the other. Perform a side plank on the side that's lagging and reassess. It should improve if it's simply an activation problem, otherwise it helps to narrow down the problem to a structural/muscular or alignment (though not very common) problem. 

Mobilizations to Improve Hip IR

Kneeling Glute MOB

  • Set up on all fours with hands under the shoulders and knees under the hips.

  • Maintain a slight arch in the lower back and place your right foot on the back of your left knee.

  • With your back set sit back into your right hip and hold for a 1-2 count before moving back. Perform 5-10 reps on both sides.

Lying Knee Pull Ins

  • Lie on your back with your knees bent and your feet flat on the floor.

  • Exaggerate the width between your feet.

  • Think about trying to internally rotate your femurs which as a result have your knees touch together while keeping your feet on the floor. Hold for a two count and return to the starting position. The stretch should be felt in the hips and not the knees.

  • Perform 8-12 reps before working out.

  • Good for those with muscular restrictions.

Prone Windshield Wipers (TEST #2)

  • Lie on your stomach with your knees together and feet up in the air.

  • Keeping the knees together, let the feet fall out to the sides.

  • Hold for a two count and return to the starting position.

  • Perform 8-12 reps prior to workout.

  • This is great in particular for those with a capsular restriction.

Passive Internal Rotation Stretch

This goodie comes courtesy of Dean Somerset. This is more of an advanced stretch and would be sure to be able to knock out all the above aforementioned ones before using this one to help maintain proper hip IR.

  • Sit at the end of a table or elevated step and lift one leg back into internal rotation as shown.

  • Progressively work your work close to the table, and hold for 30 seconds.

  • Repeat on the other leg.

I hope that this post will help steer you in the right direction to improve your lifts in the gym and your times on the trail.

If you should have any specific questions please shoot me a message and I'll be happy to try and help out. If any of this information was insightful, helpful or funny please share it with a friend!

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Social Media: Where Pros Give Unsolicited "Advice"

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It's late one night and you're scrolling through a social media feed on your phone and come across some friends working out. Like most individuals you might give them a like or comment about how that's awesome or congratulating them on a new accomplishment in the gym.

You go to the comments and see:

"Not hitting depth, smh"
"I'd be careful, your back shouldn't be like that"
"Shoot your hips back more and focus on arching"
"Leg drive! Arch! You'll push more once you learn to do that"

The "Fit Pro" Commenth

You click on the profile of the individual who left one of these types of comments and discover they're trainers and coaches who've decided they know best on how EVERYBODY should train.

Now I'm not talking about the fitness enthusiast who fancies themselves an uncertified trainer because they have a six pack or competed in a powerlifting meet. I'm talking about a true "professional" who puts food on the table training others. These are the guys I have a gripe with. I used quotes because these "pros" aren't very professional. 

Here's why it's a load of bull for one fitness "professional" to call out another publicly on social media.

I'm ACE, NASM, NCSA, ISSA, ABC123 CPT

While you may not agree with what you're seeing, it's also not your job to be judge and jury for all things fitness simply because you passed the most rudimentary of Personal Training certifications. Nor does ripping off someone else's training philosophy and system suddenly make you an expert. As a professional it is your job to help YOUR clients and contribute to the fitness industry. It's easy to move on and not waste your time being the form police. Instead of tearing others down why not be a positive beacon building others up by reaching out. Don't try and hijack someone else's feed by putting them down and trying to show how superior you are and why they or their followers should add you, they won't.

Did it ever cross your mind that the person you're critiquing is the very person in the video, a person who is NOT a professional but a paying customer? Now I know what you're thinking, hey if that coach did a better job the client would be moving better. Heres the problem with that line of thinking. You have no context as to how long this client's been training and more importantly how much progress said client has made.

While you may be watching someone perform a squat to a less than desirable depth or deadlift with a slightly rounded back, you didn't know that the coach wanted the client to be focused on hip positioning today. They're crushing their hip position and in time I'm sure they'll fix that back position as well. This often can be the case for very untrained individuals because they can easily become overwhelmed with dozens of cues and checkmarks. A good coach breaks things down into easy manageable steps. Sharing progress is that, progress and not the final product. Critiquing the technique of a beginner is as ridiculous as over analyzing a T-ball swing, really man what are you doing?!

Social Media Crusader

Here's my biggest gripe I have with other fitness "professionals" criticizing other pros via social media: Your critique can be the sole reason another person loses business and is unable to keep the lights on in their home. Said client may read your comment and decide that maybe their trainer isn't good and decides to stop. While you may think you're doing a service to the industry, all you're doing is a being a jerk. I've meet thousands of trainers, some good and some needing more CEU's, but for the most part they've been good people. Judging others coaching abilities isn't up to you! Who are you to be reaching in and taking money out of somebody else's pockets?! Don't be upset with them, be upset you aren't better at marketing your services to help more people. 

I firmly believe the cream rises to the top. If a coach is good they'll succeed on their own, just like they'll run themselves out of business all the same if they don't deliver results. It shouldn't be because you're planting the seed of doubt into their client's head. Yes sometimes these coaches have their clients performing less than stellar technique on a regular basis but also remember that their poor training only highlights how good you are without saying a single word. 

If you really feel the need to criticize another coach, for all that is good and holy just send them a private message.

Lastly lets stop being lazy with these bot comments and copy+paste DM's. I get you're trying to build up your following but you're trying to do so by being lazy and trying to take a short cut. Some of these comments don't even make sense, I'd ask for a refund for that bot if I were you.

I continue working on my own social media presence, it takes work and if you're a true professional, you'll be working on it yourself. 

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Personal Training and Massage

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Walk through your local gym you'll see dozens of personal trainers stretching their clients. No doubt this has been going on forever, but is technically outside of the personal trainer's scope of practice.

Scope of Practice- Procedures, actions, and processes that a healthcare practitioner is permitted in undertaking. 

Scope of Practice for Personal Trainers (according to NSCA)

 "Developing and implementing appropriate exercise programs, assisting clients in setting and achieving realistic fitness goals, and teaching correct exercise methods and progression.” 

Nowhere in there does it mention any sort of muscle manipulating techniques.

Ouch That Hurts

Hey can you move back to that other spot...a little lower....YEAH! OUCH! You got it. 

This was a typical exploratory palpation session with clients whenever they were unable to release muscle on their own and so it made sense for me to get it out for them so we could get back to training. When I started doing bodywork I had already been a trainer for over 5 years and was decently versed on anatomy and biomechanics.

This all is a rationalize for what I was doing, which was outside the guidelines of my liability insurance and scope of practice. The results I got were positive across the board, but I also knew I wasn't allowed to do what I was doing. The more injuries I would encounter, the better I got at feeling healthy tissue and fibrous restrictions in the fascia and muscles. Though in the back of my mind I knew what I was doing was illegal.

I observe dozens of coaches, many of whom I see jam their elbows and fingers in areas where they shouldn't be. And not because now that I'm a manual therapist I'm on my high horse but because they're actually pressing down, rather hard I might add given the discoloration of the skin around said area, into a place where there's way too many nerves or organs.

Pot Meet Kettle

I will never tell any other coach they shouldn't be placing their hands on their clients, because that would make me a giant hypocrite. I do however advise these coaches to exercise ALOT of caution. In an effort to add value to sessions coaches range from the harmless assisted static stretching to downright dangerous let me dig my elbow into your anterior triangle. 

What I've Learned

I Didn't know WHY only how
A Manual therapist, massage therapist or LMT has undergone more extensive training than personal trainers where it pertains to understanding of how and more importantly WHY to work in a given area. They learn more manual muscle testing and specific assessments to address movement compensations. I could copy a technique but didn't fully grasp the methodology behind it.

Most trainers who perform assisted soft tissue via foam roller, ball or roller stick think: harder is better. It's not.

Getting work done on you doesn't in turn show you how to treat your clients
Copying a given technique performed on you might help YOU, but could injure your client. In the same way you wouldn't give a 65 year grandma the same exercise protocol a 25 year old would receive, the same goes for soft tissue manipulation. In the past I've seen coaches receive a quickie treatment only to see them performing the exact thing on their clients that same evening.

I hadn't earned the right to put my hands on clients. Trainers are not therapists.
Many colleagues who are both manual therapist and trainer had to juggle massage therapy school and a full slate of clients at the same time. Depending on where they're located, schooling can range from 500 hours to over 1000 hours. And while this may be a lot or a little depending on how you look at it, it's a large commitment for anyone with full time obligations. 

Trainers are not physical therapists. Most of the corrective exercises seen today don't work because the coach implementing them lack an understanding that the issue needs both manual therapy and corrective exercise.

I of course will not fool myself thinking that I am anywhere near the level of a DPT (Doctor of Physical Therapy) either. I always had a firm grasp on anatomy, or so I thought. I came to see that I lacked a comprehensive understanding of:

  • Origin and Insertion sites
  • Layers above and below muscles
  • Feeling the difference between muscle and organ
  • Progressions for treatment
  • Contraindications with degenerative and acute diseases or injuries

I understand now I had not earned the right to put my hands on a single client because I had not committed to fully understanding the topics above. I had not put in the time, literally. I thought because I could recite muscles and actions off the top of my head that I could manipulate muscles. I was wrong. On one hand all the clients I've helped has allowed me to get a head start on my education in treating soft tissue restrictions but I also understand I probably shouldn't have ever laid a hand on a single person, no matter the outcome. 

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3 Reasons Your Lower Back Hurts That Has Nothing To Do With Your Back

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Lower back pain is something most of us will deal with at some point in our lives. You bend over to pick up your kids or tie your shoelaces and BAM! out of nowhere your back goes out. An overwhelming number of low back injuries stem from chronically poor body mechanics and even more likely from poor everday posture.

If you’re reading this on your phone, take a moment to sit up straight and pull the phone up so your neck isn't being cranked downwards.

Here are three things you need to know about back pain:

1. Back Pain Worse After Standing- Extension Based
 Back Pain Worse After Sitting- Flexion Based

For those who suffer from extension based back pain this is likely caused by: Short Hip flexors, poor glute activity and a lack of anterior core stabilization. The combination of weak glute function with shortened hip flexors often leads to lumbar extension substituting for hip extension during activities such as deadlifting, jumping, and running. Put simply if you aren’t putting your glutes into it, you back will be. 

A sure fire postural sign a person is a candidate for extension based back pain is viewed from the side via anterior pelvic tilt, or the back of your pelvis is higher than the front.

I meant to take a buttfie

I meant to take a buttfie

Flexion based back pain often afflicts those who sit for long periods of time like office workers or truck drivers. The main muscle that creates problems for these individuals is the Psoas. This is the only hip flexor that remains active once you draw your leg up above 90 degrees. Those seeking hip flexion like during a squat will get lower back rounding instead. Their problems are aggravated by a host of other factors such as: Poor glute function, cervical spine positioning, lack of thoracic spine extension and poor anterior core stability.

Someone with this type of back pain is in a catch-22. They need to stop sitting so much but they likely sit a lot due to work. For this individual I would recommend setting a timer to periodically stand up and stretch to break up the monotony. Along with taking time each day to use a foam roller or lacrosse ball to break up any soft tissue adhesions formed in the hip flexor muscles.

2.     Not All Back Pain is Due to “Tight” Hips

From an anatomical standpoint the hip flexors are a combination of muscles: illiopsoas, sartorius, and rectus femoris.

Lets focus on the Psoas.

The psoas attaches through the side of the lumbar spine and connects to the discs in the area of T12-L5. Because of this vertebral origin point, the psoas is also involved in 360 degrees of spine stabilization.

For those who believe they have chronically tight hip flexors, stretching them isn’t going to magically solve the problem because the underlying cause may not be tight hips but an unstable spine and poor core strength. If a muscle is short and tight, stretching it won’t release any neural tone which only leads to it tightening back up afterwards.

Their issues may be solved simply through core and glute activation.

A properly performed plank will solve all that ales you. Not only because by staying in a neutral position will you decrease recruitment of the illiopsoas but also by squeezing the glutes hard you’ll force the muscle to relax due to reciprocal inhibition.

Talking about hips and glutes leads me to the final point

3.     Poor Internal-External Hip Rotation

A quick screen for both:

Need Internal Rotation 35 degrees

External Rotation 45 degrees

Less than stellar results?

Corrections:

Need Internal Rotation- Side Plank

External Rotation- Prone Plank

The muscles that resist internal rotation are all located on the outside of the hip. By stimulating these muscles it forces them to all stabilize the spine and possibly allow your hips and core to work correctly.

On the other side of the equation are the muscles that resist external rotation found on the inside and anterior aspect of the hip. All these muscles co-mingle when it comes to core stability. Like in the aforementioned tip, when a properly performed prone plank is performed, the hip flexors are held in a tight stretched position to help the hips and spine stabilize.

Correcting these restrictions can bring relief to those suffering from chronic lower back pain. These screen are the beginning to figuring out if you need more mobilization or simply needed more stability. 

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How to be a Healthy Runner

The key component to more efficient running and avoiding most injuries is improving on landing softly. Not exactly groundbreaking advice but how does one go about learning to absorb contact more effectively?

First thing to address is technique. Landing hard on your heel is often due to over-striding instead of landing with the foot underneath your hip. Butt-kicks mimic where your foot shot be landing, when you're warming up perform a few meters of butt-kicks before resuming your regular stride.

Second would be posture. You want to maintain a slight forward lean which will in turn aide in your ability to use gravity to land more mid-foot. I always think hips high and run tall. I would be remiss if I didn't mention not everyone likes to run with a forefoot landing, preferring a heel landing, which still doesn't change the focus of today's topic of "landing softly". Many elite long distance runners are heel to toe type runners, so you have to find what sort of stride works bests for you. 

Often heard advice on running faster is increasing cadence, or stride frequency, but if you're plodding along loudly like a hungry dog the only thing that's going to increase are hip, knee and ankle issues. 

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The final thing I would address is strength training protocol. Are you performing any type of jump training? It's important to focus on absorbing contact just as much as it is in learning how to produce more of it.

Here is a Depth Jump progression that can help you start running 

Depth Drop

  • Teaches you how to land properly and absorb the impact.
  • The mechanics are similar to squatting, I would not have a client perform any type of plyometric work until they can properly demonstrate a basic understanding of the squat. 

Depth Jump

  • Like the depth drop, upon landing immediately dip back down and explode up. 
  • Focus on landing softly.

Single Leg Depth Jump

  • Stepping off a 12 inch box, landing softly with both feet. 
  • Using only one leg, dip down and jump straight up. Land softly and repeat. This time by jumping off the other foot upon landing. 

Depth Broad Jump

  • Step off a 12 inch box, landing softly and immediately performing a broad jump.
  • Focus on using the hips, full extending, and once again land softly.

Ice Skater & Bounding

  • Ice skater focuses on lateral absorption and power development. 
  • Motion needs to occur from the hips, land softly. As competency increases, so can speed of the movement. 
  • Bounding is a forward motion, great for working on timing, footwork, and linear power development. 

Give these a try and see how it might improve your ability to run faster, run longer and stay injury free. 

 

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