Having come across yet another article and research study highlighting the meteoric rise of injury rates with young athletes specializing in one sport, it got me thinking about what many of us older (and not necessarily wiser) adults do on a regular basis, especially us runners. How many of us actually get out of our comfort zone of running regardless of speed or interval/distance? How many of us actually mix it up on a regular basis? Oftentimes, we fall into that specialization category at some point or another much like young athletes these days, and understandably so given our schedules. It is no surprise then that running related injuries are so common.
With winter fast approaching, it is a perfect time in the northeast to break the habit of specialization temporarily, and consistently get out of your comfort zone so that you can come back stronger and reduce the likelihood of injury during the busier months of training and racing. It is your chance to build whole body robustness and resiliency as you can explore other movement patterns besides running straight ahead. This idea is especially important because running isn't just a single plane activity. While the majority of movement is forward obviously, there is a lot going on side-to-side and with rotation, mainly in terms of stabilization. This is where getting out of your comfort zone really pays dividends as you can challenge all 3 planes of movement resulting in improved running efficiency and, more often than not, fewer injuries.
Some ideas for the winter:
1. Drill work. Think form and technique and reinforcing the skills required for an efficient running gait. Regardless of your individual style, there are certain foundational skills worth mastering to improve performance which doubles as a countermeasure to many common running related injuries like tendinitis and stress syndromes. A great resource for guidance and ideas is Chris Johnson as he is constantly posting excellent videos related to this very topic. To be perfectly honest, this is a great adjunct to training regimens year round anyway.
2. Strength Training. Like drill work, this is also highly encouraged to incorporate into your training routine on a regular basis as there is no downside to strength. However, during the off season of winter, different goals can be addressed and different training strategies can be used. It is a great time to train more as a total athlete working on some areas that might be missed during the busier seasons and stress total strength in all planes of movement. Variations of multi-joint exercises like dead lifts, squats, pulls and presses along with unilateral versions is a way to help balance and bulletproof your body for the demands of running. For inspiration, ideas and intelligent programming, check out Ben Bruno's YouTube channel. You will not be disappointed.
3. Cross Country Skiiing. I've not come across a more challenging total body activity, except for rowing possibly, than cross country skiing. You don't have a choice but to use every part of your body which makes for a highly efficient exercise. Both styles of cross country skiing, skate and classic, are demanding but skate can be particularly advantageous since you spend more time in multiple planes of movement working different muscle groups than the straight ahead style of classic. It's also faster and more enjoyable in my opinion. The Shawangunk Nordic Ski Association is a great resource to keep you up to date on all of the trails and conditions locally.
4. Snowshoeing/Winter Hiking. Whether or not there's snow, getting out on some of the trails and high peaks around here, especially in the Catskills, is an excellent workout. There is plenty of variation and level of difficulty making it accessible for all skill levels. Hop on some single track to add another element of difficulty and to improve your technical proficiency on some of the gnarly terrain. Add snow to the mix and then you can throw on a pair of snowshoes making for a completely different challenge and experience.
5. Swimming. For those that want to stay inside, swimming is always an excellent alternative (or so I'm told since I'm still in a perpetual learning phase). Like cross country skiing, this is another total body activity that will engage different muscle groups than running does allowing you to be more of a complete athlete who happens to run instead of only a runner.
Winter doesn't have to be a true off season and you can break the cycle of specialization. It can be the perfect time to make gains in a variety of ways that can work in your favor come springtime when you're logging your miles again. So get out of your comfort zone and reap the game changing rewards of improved performance and fewer injuries this year!
Knowledge = Power; Share The Power:
In three short days, the Rock & Snow Bridge 2 Bridge 5 Miler put on by the Shawangunk Runners to benefit the Mohonk Preserve will kick off the 2015 racing season in the 'Gunks. This is the same race for those that have run it in August in the recent past. So far the forecast is looking about as good as possible for a Saturday morning in April: partly cloudy skies with temps in the high 40's/low 50's by race time most likely. Compared to August, racers will get to enjoy the early signs of spring along the trails and a couple of rushing streams (bridges provided) from this winter's snowmelt instead of the mountain in full bloom.
For those unfamiliar with the course, it is a pretty simple course. (Disclaimer: I do not run with a GPS so nothing will be exact but you can expect my estimations to be pretty close.) It is an out and back with a short loop just about halfway through. The first 2-2.25 miles are relatively flat with changes in elevation in the 1-3% range on carriage roads traversing the two bridges that give the race its name. You'll hit the first bridge just over 1 mile in and the second bridge is close to the 2 mile mark. Other than some leaves and small branches, conditions are very good. There was a little bit of ice leading up to the first bridge on the way out but this will probably be gone by race day. When you get to the loop section, there is a sharp left turn that begins a short hill (less than a quarter of a mile) on a less traveled trail. About halfway up, there was another small patch of ice but chances are good that this will be gone over the next few days too. After the short hill, it'll flatten out before making another left turn to make your way downhill back to the original carriage road. The loop is close to half a mile and conditions are a little mushy in parts, especially on the downhill section so you'll want to be aware of your footing. There were also more tree branches down and one tree to climb over so be prepared for that as well in case it is not removed before the race. After the loop, you'll make a right turn onto the carriage road again and you'll have a little over 2 miles back over the bridges and to the finish line which is a short extension beyond the starting line. When you pass the starting line, it is a little less than half a mile downhill to the finish...a good place to catch up to anyone in front of you!
Overall the conditions will be pretty good for the course and there is definitely no need for any special footwear. It should be a fun, flat and fast course and is perfect for all skill levels!
For more information, you can head over to the event page and if there are still spots available, you can register as well! I'll see you out on the course!
Knowledge = Power; Share The Power:
Happy Spring! It may not feel like it just yet considering there's still a decent amount of white stuff out there but I'm sure all of you golfers are itching to get out on the links! While the last remnants of snow melt away, the greens dry up and the courses are prepared, now is the perfect time to jump start your season with some easy preparation of your own. Here are three simple drills that can be performed almost anywhere to improve upon last year's season:
Open Book/Thoracic Rotation: The objective of this drill is to maximize movement and mobility throughout the thoracic spine and shoulder blades which can increase your club speed for those long par 5's. Perform 3 sets of 15-20 repetitions on both sides.
90/90 Lower Body Rotations: The objective of this drill is to promote mobility, stability and control throughout the hips, pelvis and lumbar spine which you will need to create the power required to get out of the deep rough and sand traps. Perform 3 sets of 20-30 repetitions total (10-15 per side).
Turkish Get Up: This is a fantastic total body exercise that will really challenge your mobility, control and overall strength which can benefit all aspects of your game from the tee box to the greens. Perform 3-5 repetitions on each side with a weight that allows you to maintain proper form and technique from start to finish.
Give these a shot as you prepare for your season and I am confident you will enjoy improvements in your game. Maybe you'll even win a few more bets and longest drive awards!
Knowledge = Power; Share The Power:
I have been running with relative consistency for the last 17+ years, a little over half of my trips around the sun, but it is fairly recently that I started asking myself this question: Do I ever practice how I run? To me, it is something routine and, dare I say, "natural" at this point in time but this question really struck me a few years ago after running a track workout and noticing all of the different "styles" of other recreational runners. Quite honestly, I am not sure how so many of them appeared to be running pain free with their unique versions. My answer back then was essentially 'no' but after so many years of running, I knew my typical style at the time and that I was symmetrical for the most part. Thankfully I had dealt with few injuries as well so I never really felt the need to analyze and practice my running technique and skill.
Now that I have had several years to ponder this question and work with many injured runners, I am fully convinced that running is a modern day skill requiring practice and is not as "natural" of a movement pattern as it used to be when humans were running in the savannas of Africa. We all grow up running (and are usually told to stop running in the house!) but add modern lifestyles to the equation and most of us stop running consistently so that motor pattern is not repeatedly reinforced. Take into account a plethora of other factors like strength, balance, everyday shoe choices, genetics, work requirements, mode of transportation, training schedules, etc. and performance of that motor pattern can, and most likely, will change over time. This is not unique to running. Take any skill, swimming, hitting a baseball, or shooting a basketball just to name a few, and I think we can all agree that the same holds true. Mindful repetition and practice of a skill dramatically improves the consistency and performance of that skill so why would it be any different for running? I highlight 'mindful' because repetition itself does not necessarily mean that someone is actively engaged in practicing a given skill. In the case of running, anyone can go run mile after mile without actually practicing.
This becomes a potential issue when you start talking about injuries. It is commonly reported that 80% of runners in a year will sustain an injury. My question now is how many of those injured runners actually practiced how they ran? I believe that the majority would say no. That being said, I cannot assume that that is the primary factor in each of those cases but I would have to argue that it is a significant factor for many runners. Running has become a modern day skill and should be treated as such. Introduce the idea of practicing it in a mindful manner and I believe that the percentage of injured runners would drop and performance would improve.
So if you ask me the same question today, my answer is most definitely yes! Mindful practice of how I run along with the rest of my training has corresponded to 2+ years of being injury free and a steady improvement in performance. Granted, I am only an experiment of one and correlation does not equal causation but I do not think it to be coincidence that practicing how I run and not simply running a lot has led to successful and injury free running! Now I pose the same question to you:
Knowledge = Power; Share The Power:
The more I practice as a physical therapist and work with all kinds of different people, the more I realize how important and powerful words are. About a month ago, I was reminded of this when I was working with a young man who has had a wide range of persistent pain and physical limitations for many years that have significantly changed his life for the worse. It even got to the point where he had to quit a job after one day of work.
Everything began when he was in high school and had surgery on his feet. Since then there has been a cascade of events and misinformation that has landed him where he is today. He sought help from a number of different practitioners over this time but one of the episodes stands out. At one point a comment was made about his feet and how they were forever changed due to the surgeries. His "foundation" was permanently altered and he would have to make changes in his lifestyle. Fast forward to now and these words have been in his head for a long time influencing his life in ways that the practitioner probably never expected. For example, he wasn't sure if he could or should run even though he wanted to.
Now I am sure there was no intent by the practitioner to create this kind of reaction but it is a perfect illustration of what words can do and the power that we, as healthcare providers, can wield. Voltaire famously said, (or Uncle Ben from Spiderman if you prefer), "With great power comes great responsibility," and I am completely convinced of this as a physical therapist. When a client enters my office, there is an expectation that I am an expert in my field and have answers to his/her questions. My words have weight and meaning, and because of this, can be extremely influential both positively or negatively. I do not take that idea lightly and for that reason, I do my best to choose my words very carefully in order to have the best outcomes possible. Ultimately, my goal is to dispel fears and myths and use language and education as another powerful tool to help my clients reach their goals.
As the consumer, you have the power to ask questions and understand the reasoning behind what myself or any other healthcare practitioner is saying. (To be clear, I am obviously not talking about emergency situations.) It is important to ask 'why' if something does not make sense. It is healthy to have some skepticism to protect yourself when you hear or read something that does not make sense, rubs you the wrong way or is flat out wrong. That is the beauty of the second opinion. You can choose what the right fit is for you based on a number of factors, words and language being one of them.
Whether I was the second, third or fourth opinion, I am glad that this young man was able to find me and finally get help, advice and guidance that has reversed some of the negative consequences already. The situation was a great reminder and learning tool for me and I hope it will be useful for you as well.
Knowledge = Power; Share The Power:
Five days from now on November 9th at 11am, the gun will go off in the Shawangunk Mountains to start one of the most picturesque races you can find in the Mid Hudson Valley: the After The Leaves Have Fallen Josh Feldt Memorial Half Marathon (formerly 20k) organized by the Shawangunk Runners. The competitors will traverse many of the spectacular carriage trails throughout Minnewaska State Park with highlights including Lake Minnewaska, Lake Awosting and Castle Point which offers incredible views of the Hudson Valley. It is easily one of my favorite races to compete in and a great challenge to complete before winter gets under way.
As of now, the forecast is calling for chilly temps in the high 40s to low 50s most likely with some clouds since there is a chance of showers later in the day. Having spent so much time at Minnewaska one piece of advice I can offer is that there is definitely a microclimate up in the mountains so do not be surprised if that forecast changes a bit once you get up there. You may want to have a couple of wardrobe options depending on what the weather turns out to be at 11am. At least it does not look like we will get the wintry mix that we experienced last year.
And now for the course preview. Take note that the course has changed, mainly at the beginning and end, compared to the 20k course. Disclaimer: I do not have a GPS watch so the mile estimates are close but not exact. Here is a link to a map of the park to follow along.
This year the race will start near the upper parking lot at Lake Minnewaska as usual and will head out clockwise around the lake to the large picnic area, roughly half a mile before looping back past the starting area. This first mile will have a relatively short hill up toward the picnic area and then it will obviously be down back to the starting area. From there you will go downhill and make a right onto the Upper Awosting Trail (green blaze). This will take you about 3 miles to Lake Awosting on a gradual but steady incline with a handful of flatter and downhill sections to catch your breath. When you reach Lake Awosting, you will turn right to circumnavigate the lake counterclockwise (black blaze) which is another 3 miles. There are a couple of rollers around the lake but this is a good place to cruise saving some energy for Castle Point. You will also want to pay attention to your footing as this will be the most technical part of the course since it is a less traveled trail compared to the others and has a fair amount of leaves and pine needles. Right now there are only a couple of wet/muddy spots mostly after you get around the lake near the "beach" area. This could change with some rain expected to come later this week. Leaving the lake, you'll be begin a gradual ascent to the Castle Point trail (blue blaze). It will be a right turn when you reach the Castle Point trail and this will be the hardest section of the course. From here it is about 1.25 to 1.5 miles uphill to Castle Point with the latter half being more steep than the initial climb. Enjoy the views, grab some water and then reward yourself with about 3 miles of downhill running with a few speed bumps mixed in. It is a gentle downhill most of the time so you can really take advantage of this and make up some ground without worrying about taking a pounding. This will connect you back to the Lake Minnewaska trail (red blaze) which you will make a right to go around the lake counterclockwise for the last 1.5 miles to the finish. After the right turn and a short incline, you'll head downhill to the end of the lake opposite the start and finish area. From here you will have to conquer one more decent hill up to the picnic area from the beginning of the race and then it is downhill again for that final half mile.
It is a fantastic and challenging course for all skill levels on some of the best trails in the area so throw on your racing shoes and I'll see you there!
For more information, you can head over to the Shawangunk Runners website. There may even be some spots left so register now before you miss out!
Knowledge = Power; Share The Power:
What is every 2 year old's favorite question? "Why?" Inquisitive toddlers have a lot to say and even more to ask. Why do you eat that? Why do you run? Why this? Why that? They are like little scientists wanting to know why their world works the way it does. They want to know the reason behind something and "just because" is not a good enough answer for them. It is this kind of inquisitiveness that we should always nurture within ourselves allowing us to remain the scientists that we start out as.
The reason this comes to mind is the staggering amount of information (and misinformation) that is now accessible to so many people through the creation of the world wide web. It is open to anyone (like myself) who wants to share knowledge, opinions, expertise, etc. to the masses. Unfortunately, this is a double edged sword. On the one hand, you have more access to excellent resources on any topic you can possibly think of. On the other hand, you have the same access to questionable resources and information about those same topics which is very concerning. Since this is the case, asking "why" like a two year old to make sure something makes sense will prove to be very beneficial instead of just accepting something at face value.
This is most definitely the case with the health, fitness, rehab and nutrition worlds. There is no shortage of dubious information, outrageous claims and downright zealotry about health and the human body. Perhaps I am becoming more critical of what I read on the internet as I continue to practice as a physical therapist and do my best to keep up with current evidence and literature but it seems as if the frequency of questionable (and just plain wrong) articles and headlines I come across on a daily basis is increasing. This becomes incredibly dangerous with social media's capacity to disseminate information so you get all sorts of myths (and truths, thank goodness) spreading like wildfire. Despite countless individuals and organizations doing their best to discount bad information, beliefs continue to persist and get in the way of facts. There also continues to be this idea that "But I read something or I saw something online" equals truth. It reminds me of this commercial:
Not everything on the internet is true. Somehow it has become the media's job to sell stories and latch on to hot topics rather than report and publish legitimate information as objectively as possible. Bloggers (like me), writers and "experts" among many others are trying to gain visibility within their respective fields in a very crowded health landscape and although the majority of intentions are good, it still does not make something true. Just because everyone is posting on Facebook does not make something true. And just because someone has some letters after their name also does not make something true. With all of this in mind, I strongly encourage you to read and listen with caution and to question everything (including me) as a two year old would. Why? Does that make sense? If I don't sit straight all of the time, I'll develop low back pain?! Gluten is the devil?! (I'll answer those last two for you: No and no.) Take a few minutes to double check what you read and listen to, and seek out credible and reliable sources so that you can truly make healthy and informed decisions.
Like that old saying goes, if it's too good to be true, then it probably is.
Knowledge = Power; Share The Power:
Earlier this summer, I became another victim of Lyme disease in the Hudson Valley. Shocking, I know. It's pretty amazing I've made it 31 years before finally succumbing to one of those nasty little ticks considering how much time I spend outside and in the Shawangunk Mountains. Thank goodness I had a successful and relatively uneventful course of treatment with antibiotics. When it was confirmed I had Lyme, I was ticked off to say the least so when talking with friends and family, I was telling them that Lyme got stuck with me, not that I got stuck with Lyme. It was a simple shift of my mindset but I was determined to beat the you-know-what out of that stupid tick and its "gift" to me. It messed with the wrong human!
But it also got me thinking about how people and clients I have worked with tackle injuries, pain and physical limitations. More often than not, I have a very good idea of who will do well with physical therapy and who might not be as successful before I even start treatment. Although they are contributing factors, it usually isn't age, gender, fitness level or severity of injury that predicts success. It is a positive mindset and "what do I have to do to beat this?" attitude that makes a huge difference versus a "why did this happen to me?" attitude. I realize I am speaking in generalities and there are always exceptions to the rule but time and time again those that jump head on into whatever challenge they face and are motivated to do whatever it takes to get better usually do.
I am reminded of one of my favorite clients from a few years ago. At the time, she was 70 years old and had fallen resulting in ligament tears on both sides of her right elbow. It is bad enough when you tear one a la Tommy John, let alone two! One major surgery later to repair the ligament damage and she was scheduled for her physical therapy evaluation with me. Right off the bat I had a good feeling about her because "she didn't have time to be slowed down" by this. She wanted to get to work and I got lucky because she made my job very easy. Given her age, severity of injury and tissue quality, it would not be unreasonable to think she might end up with some limitations after such a major injury and surgery but again "she didn't have time for that". Couple that attitude with a great sense of humor and she beat all expectations and then some. I am convinced that her success was largely due to her positive mindset and less about my skill as her physical therapist.
So my question is when pain, injury and physical limitation shows up for whatever reason, who got stuck with who? I prefer to think that it got stuck with me and picked the wrong human to mess with. I encourage you to think the same.
Knowledge = Power; Share the Power:
A couple of weeks ago I came across two things that really hit home and gave me one of those "aha" moments. One was an article on a blog I follow and the other was someone's "testimonial" for her current fitness choice. The common theme between the article and testimonial is that movement rocks! So often we take for granted the ability to move without any limitations and do whatever we need or like to do. It usually takes an injury or physical limitation to remind us how awesome it is to move or a change/increase in activity level to remind ourselves what we've been missing. Either way, the conclusion from both of these scenarios is the same with regard to movement. As the old milk commercials used to say, it does the body (and mind) good. On top of that, I would add that it is addicting (in a good way).
In the article, entitled "The Privilege of Movement", the author, Neghar Fonooni, reminds us that movement is a choice. In it she says "It's not an obligation or a begrudging requirement - it’s something to be eternally grateful for. Movement is a privilege, and one which we should honor daily...[by] making fitness enrich your life, not detract from it." Now fitness means a lot of different things to a lot of people as it should. That's the beauty of it since there is no one size fits all definition. At its core, however, I would argue that a major component of fitness means being able to move independently and satisfy your physical goals without any limitations rather than some number or image you are supposed to adhere to. Whether you accomplish that by going to a gym, heading to your local yoga studio or hiking with your dog, in some ways it does not really matter as long as it is something you like to do. The choices are endless. As long as it remains a positive element in your life and continues to enhance it then at some level you are probably addicted to movement without even knowing it. Now it's still important to mix things up and keep your body and mind engaged so that you don't get stuck in a rut and lose interest in making that choice to move altogether. We all know the outcomes when you choose not to keep moving and they are not pretty.
The "testimonial" was a bit of a different flavor in that it perfectly exposed the importance of movement on the brain. I am not the first person to make the connection of fitness/movement with changes in the brain and I will certainly not be the last either. There are plenty of researchers who have beaten me to the punch but after reading the next two quotes, it is quite obvious and you won't have to bore yourself with dry scientific publications. It began with, "I looked in the mirror and didn't know who that was. I was tired, weak, sad, embarrassed of my body and just felt plain old ugly." After a recent change in her activity level and choosing to make movement and fitness a priority, this same person now says, "I feel strong! I have tons of energy! I feel positive about myself and what I can do, in and out of the gym. My kids think of their mom as strong! I am happy." There has been a total transformation in her brain and mindset thanks to the power of movement and fitness. It is quite clear from this example that physical fitness and mental health go hand in hand. And those last three words are awesome! Happiness is pretty easy to get addicted to!
I could keep adding more anecdotes, articles and research studies reiterating the same ideas but that would be very boring. Why not be an experiment of one and make the choice to find the right kind of addiction to enrich your life?
You can also check out Ben Bruno for the article that inspired this post as well as find great information on training and programming for your movement, fitness (and brain) goals.
Knowledge = Power; Share The Power:
I'm not one to subscribe to a lot of toys or gadgets to provide treatment and help my clients reach their goals but I do get excited when I find one that works and works really well. Thanks to fellow physical therapist, Erson Religioso, I now have in my possession an excellent new tool, The Edge, that makes my job easier and more effective which is great news for my clients. It may not look like much (or it may frighten some people) but it is an excellent all around tool for Instrument Assisted Soft Tissue Mobilization (IASTM).
As much as I enjoy using my hands, there are times when a tool or instrument can really be a huge advantage and difference maker. There are also some tissues in the body that fingers and hands simply cannot have as much of an impact on like metal or other hard objects can. Since The Edge is a 'Jack of all trades' with its variety of edges, it can be implemented in many ways depending on the specific needs of each client and situation. That means having the ability to match the appropriate edge for treatment and truly target the particular issue at hand. The beauty of it is just like many soft tissue techniques, it can be utilized for both prevention and/or treatment for injuries. Admittedly, it saves my hands for other treatments and techniques as well.
With its versatility, The Edge can be used for a wide range of issues like tendonitis/tendinosis, muscle strains, trigger points, etc. It can be used for acute or chronic scar tissue formation especially following surgical procedures so that movement and mobility can be restored. Persistent or chronic muscle tightness (think calf and upper trapezius) tends to respond quite well to IASTM. Any type of restriction in connective tissue like the plantar fascia, iliotibibial band, and joint retinaculums are also prime candidates for tools like The Edge. As you can see, there are many applications for IASTM as it can be the perfect adjunct to other techniques and treatments to help you move better, feel better and live better. Sometimes it can the missing piece to help you get over the final hurdle that has been a challenge to get over otherwise.
If you have any soft tissue issues or just want to stay ahead of the game with preventative treatment, don't miss out on this opportunity. It really can be a game changer!
Knowledge = Power; Share The Power:
Dr. Greg Cecere
Your personal physical therapist, movement educator and knowledge dispenser.
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The contents of this blog is meant for educational purposes only. Momentum Physical Therapy of New Paltz and Dr. Greg Cecere are not responsible for any harm or injury that may occur due to any information on this blog as it is by no means a substitute for a thorough evaluation by a medical professional.