PTC: PREPARE TO COMPETE RUNNING/MULTISPORT INJURY PREVENTION CLINICS

©BOCHNER CHIROPRACTIC & SPORTS INJURY CAREDr. Marc Bochner, Board Certified Sports Injuries, Active Release Techniqueswww.bochnerchiropractic.com681 Lexington Ave., 5th Floor212-688-5770 Dr.Bochner@att.net

CLINIC OVERVIEW:

I. Introduction: Health, Fitness, & TrainingII. Mechanisms of Overuse InjuryIII. “PTC” Injury Prevention ProgramIV. Video Form Analysis & DrillsV. Five Steps to Take If InjuredVI. Injury Specifics for the “Core”(Lower

Back/Abdomen/Hip), Knee & Leg/Foot

I. Introduction: The relationship between Health, Fitness, & Training

TRAINING: PLAN to PEAK!

P=PREPARE your body well for your running and racing (Prepare to Train & Compete)

E=EXECUTE an effective training plan

A=ADAPT to challenges during training

K=KEEP your body healthy by using restorative measures.

HEALTH & FITNESS ARE NOT THE SAME THING!

Note that when health decreases, eventually fitness follows…Plan your breaks to avoid overtraining/overliving and reach peak health & fitness at the right time for your key race.

Potential

Periodization: Taking time weekly, monthly and yearly where training intensity and volume is decreased, to heal and restore energy. Balanced and adaptable training is what we must strive for.

Previous season’s mid-fitness level is new season’s base level.

PEAK

SPEED

BASE FITNESS

PEAK

SPEED

BASE FITNESS

PEAK

SPEED

BASE FITNESS

WITH PERIODIZED TRAINING, THE BASE LEVEL OF FITNESS RISES EACH YEAR!

II. Mechanisms of Running and Triathlon Injuries

There are 2 types of sports injuries: TRAUMATIC and OVERUSE

TRAUMATIC: An external force acts on the body in a sudden manner.Think contact sports such as football, hockey, soccer, basketball. OVERUSE: Occur over time as a result of repetitive stresses that gradually overwhelm the adaptation abilities of the body.

Sports medicine originated with the care of traumatic injuries, but with the growth in popularity of endurance sports, new, non-surgical treatments have been developed for overuse injuries.

These treatments are aimed at discovering the cause of injury, instead of just relieving symptoms. Additionally, they usually involve the patient in the healing process, teaching motivated patients what they can do to prevent re-injury.

3 factors, PHYSICAL, NUTRITIONAL, and PSYCHOLOGICAL, contribute to the development of overuse/repetitive injury. For example, marathon training will stress all three of these factors. We are going to focus on the physical part of injury and injury prevention, but all three need attention to get you to the starting line ready to race.

physical

nutritional psychological

PHYSICAL CAUSES OF RUNNING INJURIES

INTRINSIC FACTORS: The status of our biomechanical function. •Lack of range of motion in joints, muscles and fascia•Postural dysfunction•Overactive or underactive (“inhibited”) muscle function (imbalances)•Isolated muscle tightness or weakness, left/right assymetry•Instability of motion and altered movement patterns•Over/underpronation• Leg length inequality•Hip, knee and foot alignment problems

EXTRINSIC FACTORS: How we train, external to our bodies.•The too’s: too far, too frequent, too fast•Improper footwear, worn out foot wear•Improper running form/technique•Improper running surface•Abrupt change in running surface

HOW DO THESE FACTORS LEAD TO OVERUSE INJURIES?

1. Combinations of the above two groups of factors gradually overwhelm the bodies ability to recover between bouts of exercise. For example, if you are only running 2 or 3 miles a few times a week (extrinsic factor), but then increase your distance and/or your frequency, a previously silent intrinsic factor such as hip flexor tightness and poor core strength will emerge in the form of some level of pain.

2. The added challenge is that the musculoskeletal system adapts slower than the heart, lungs, and energy delivery systems to new training demands. The muscles and tendons get “broken down” to a certain extent when you push harder, and must have recovery time to heal and be stronger than they were before. (There actually are specific locations in these tissues at all anatomical areas of the body where healing from exercise overload is slower and where injury will occur. One reason is poor circulation at those areas).

3. Thus, we must be aware of how our bodies are recovering from exercise to prevent injury, as well as pay attention to correcting the intrinsic and extrinsic faults we may have that will lead to injury.

SO, AN INJURED RUNNER MAY ASK, “I HAVE TIGHT HIP FLEXORS AND A WEAK CORE, AND I MAY HAVE INCREASED MY TRAINING TOO FAST, BUT I STILL DON’T UNDERSTAND HOW THIS INJURY HAPPENED?”

A. The answer lies in the “soft-tissues”. The soft-tissues begin with the muscles, and the “fascia” which line them and connect them, plus the tendons, ligaments and joint capsules. They are tissues that deal with the stress of running, and give us the power to move forward. When healthy, they have the ability to act like a rubber band, and store energy and release it. Thus they can propel us forward.

B. As noted on the previous slide, when we challenge ourselves with a hard workout, there is tissue damage that must heal before the next challenging workout. The damage is in the form of “micro-tears” in our muscle and connective tissue fibers. These small tears are responsible for part of the feeling of post-exercise soreness. The body will heal these micro-tears given time. But if we rush back to soon, then instead of healing and getting stronger, those areas will become stiffer, and individual fibers will be “stuck together”. You may recognize this as those “knots" in your stiff muscles, and they are called “adhesions” or “trigger points”.

EXAMPLE OF A TRIGGER POINT AND PAIN REFERRAL: QUADRICEPS

The rectus femoris, a hip flexor and knee extender, often develops a trigger point/adhesion just distal to the tendon attachment at the hip bone. This trigger point can cause pain referral to the lower thigh and patella. Further hip flexor tightness and weakness can also result, causing a “tightness-pain (trigger point)-tightness” cycle.

THE RELATIONSHIP BETWEEN SOFT-TISSUE CHANGES AND INJURY SYNDROMES:

1. These adhesions and trigger points can themselves be painful, but and they also can “refer” pain elsewhere, sometimes without being painful themselves, which can cause diagnostic confusion. An example would be pain at the knee caused by adhesions higher up in the quadriceps (see previous slide).

2. The adhesions and trigger points can also can trap nerves as well as put more stress on the tendons, joints and bones they attach to. If the points are not released, the tendons, joints and bones can then be injured as they are subject to greater than normal stress. Thus, the earlier they are treated, the less chance of the muscle stress causing tendon, cartilage or bone injury (tendinitis, cartilage tears, stress fractures). They also can perpetuate the very intrinsic factors that helped cause them! (The tightness-pain-tightness cycle). But when these soft-tissues are healthy, they can both propel us forward and help us absorb the impact forces of running properly.

3. Unfortunately, often the muscle dysfunction is not recognized until it causes more severe pain or the nerves, tendon or bone get involved.

SOFT TISSUE/JOINT DYSFUNCTION, PAIN & PERFORMANCE CYCLE

ALTEREDMOVEMENT PATTERNS

FORM CHANGES,

PAIN?

LESS POWER OUTPUT

MORE PAIN, “INJURY”

More Altered Movement,

Form

Altered Soft-Tissue & Joint

Function

Minimize/break the cycle by correcting and managing your intrinsic and extrinsic factors over time!

TRIGGER POINTS& ADHESIONS

To finish well, Preparation is key!

III. The “PTC: Prepare to Compete” Injury Prevention Program

HOW DO WE PREVENT OR BREAK THE SOFT-TISSUE DYSFUNCTION/PAIN/PERFORMANCE CYCLE ?

1. Evaluate you’re your level of health and fitness BEFORE TRAINING STARTS.

2. This evaluation will reveal “weak functional links” that may lead to injury.

3. Add treatments and exercises to your daily and weekly workouts to fix these problem areas (“prehab”). Before or part of “base”.

4. Keep your body healthy by using restorative measures to keep these areas fixed throughout the season before symptoms start!

This chart illustrates how prehab should be done before training starts…before base training . This means striving to maintain symmetrical range of motion and core strength all the time, in season and off-season, day in and day out. This is “level one” before base aerobic/strength training. “Level zero” is pain and injury and no training or training through pain!

3: Sport specific

speed/peak

2: Base Aerobic/Strength

1: Prehab/Rehab

EVALUATION OF YOUR FUNCTION FOR WEAK LINKS:

How do we find out where your weak functional links are? The answer is by checking the following:1. Posture: the relative arrangement of the parts of the body. Good posture has the muscles and skeletal structures in balance so that the body is protected against injury whether standing, lying or moving. 2. Range of motion and strength of isolated joints and muscles: the quantity of movement at our joints, created by the length and strength of the muscles which move them. Restrictions or excesses can lead to poor posture, mobility or stability.3. Movement patterns/mobility: the quality of our movements, with respect to timing and recruitment of muscle contraction in different body movements, such as walking, running, or squatting. For example, do the hip muscles work when they should when you walk, or are they inhibited, and do the lower back muscles dominate and over-contract. 4. Balance and Stability: the quality of our movements with respect to control. For example, when you squat does your knee move in too much, or your torso lean forward, and when you switch your weight from leg to leg does the torso stay centered or lean side to side.

THE PREPARE TO COMPETE EVALUATION

1. KEY POSTURE POINTS:

Front/Back view:A. Hip Heights (Iliac crest, trochanter)B. Thigh Rotation (Internal/External)C. Knees (valgus/varus)D. Tibia (Internal/external/varum)E. Feet (toe in/out)F. Arch (pronation/supination)

Side view:A. Low Back Arch (increased/decreased)B. Hips/Pelvis (forward/backward)C. Shoulders (protracted/retracted)D. Knees (forward/backward)E. Head/Neck curve (forward/backward,

increased/decreased)

1. POSTURE and MUSCLE DYSFUNCTION: The Common Dysfunctions

A) Hyperlordotic= an increased lumbar (lower back) extension.Pelvis tilts forward, hip in flexion.

TIGHT/SHORT muscles: Hip flexors (iliacus, psoas, rectus femoris, sartorius?)Lumbar extensors

WEAK, INHIBITED muscles: Hip extensors(Gluteus maximus, upper hamstrings)Deep abdominals (transverse abdominus), external obliques

B) Flat-back posture= an increased lumbar flexion. Pelvis tilts backward. Hip joint in extension.

TIGHT/SHORT muscles: Superficial abdominals (rectus abdominus)Hamstrings

WEAK/INHIBITED muscles: Lumbar extensors (may be), Hip flexors

C) Sway-back posture=pelvis displaced forward in relation to upper trunk, and pelvis is tilted backward, hip joint in extension.

TIGHT/SHORT muscles: Upper superficial abdominals, internal oblique and hipextensors

WEAK/INHIBITED muscles: lower abdominals, external oblique, and hip flexors

2. Range of Motion of Key Joints/Muscles

These joints and muscles have been shown to have restriction or extra motion in injured athletes. They can cause the postural dysfunctions just discussed, and lead to poor mobility and stability when moving. They must be within a normal range for injury-free running.

A. JOINTS: • Big toe – decreased dorsiflexion (up movement with walking/running)• Ankle – decreased dorsiflexion or plantarflexion• Subtalar (pronation/supination) • Hip- decreased internal rotation• Lumbar spine- decreased extension, lateral flexion, or rotation• Shoulder- decreased retraction, abduction, external rotation• Cervical spine- (forward head posture), decreased extension, rotationB. MUSCLES:

Often tight, shortened:• Flexor hallicus brevis/longus, tibialis posterior • Gastrocnemius/Soleus (calf) • Lower hamstring, adductors• Hip flexors/Tensor fascia latae (TFL)• External hip rotators (piriformis)• Iliotibial band/vastus lateralis (vastus lateralis can be weak also)• Lower back extensors, quadratus lumbroum• Latissimus dorsi, subscapularis, pectoralis major/minor• Levator scapulae, upper trapezius

Often weak/inhibited:• Peroneal muscles, tibialis anterior (very important for leg injuries)• Vastus medilis, vastus medialis oblique (VMO) (very important for knee injuries)• Hip extensors (very important for lower back pain)• Hip abductors (very important for knee injuries)• Deep abdominals (anit hpyerlordosis, lower back pain)• Middle , lower trapezius, rhomboids (anti forward shoulders)• Deep neck flexors (“anti-forward head”)

QUADRATUS

LUMBORUM

MULTIFIDI

PIRIFORMIS

TRANSVERSE ABDOMINUS

& RECTUS ABDOMINUS

RECTUS

FEMORIS

VASTUS MEDIALIS

VASTUS LATERALIS

ILITOTIBIAL BAND

ILIACUS & PSOAS

FLEXOR HALLICUS LONGUS TIBIALIS POSTERIOR PERONEUS LONGUS TIBIALIS ANTERIOR

FLEXOR DIGITORUM LONGUSSOLEUS MUSCLEGASTROCNEMIUS MUSCLE

FLEXOR DIGITORUM BREVIS EXTENSOR RETINACULUM AND EXTENSOR TENDONS

3. MOVEMENT PATTERNS, BALANCE, AND STABILITY If we have poor posture with muscle and joint dysfunction, then when we move we will have poor mobility, stability, and balance. This sets us up for injury as our soft-tissues work harder to absorb the forces of gravity as well as propel us forward.

There are key patterns of movement that are often dysfunctional in modern society, with its sedentary lifestyles mostly to blame (we move better in many ways as children, before we start to sit in school and especially at work). Many of the tight/weak patterns just discussed are also caused by sitting, and must be corrected for healthy, mobile aging, let alone running.

A. ISOLATED MOVEMENT PATTERN DYSFUNCTION:1) Hip extension (see weakness and overactive back extensors, hamstrings instead)2) Hip abduction (see weakness and overactive TFL, lumbar muscle (quadratus

lumborum)3) Supine single leg raise (see weak lower core, tight hamstring/calf)4) Push-up (see weak scapular stabilizers, weak core with back arch/flexed)5) Sit-up (see weak lower, deep core or superficial abdominals)6) Shoulder abduction (see overactive scapular elevators, protractors)7) Neck flexion (see overactive superficial neck flexors, weak deep neck flexors)

B. “CLOSED KINETIC CHAIN” PATTERNS FOR SYMMETRY, MOBILITY AND STABILITY:

1. Squat (see tight calf, hip flexors, hip adductors, weak hip abductors, deep core????back extensors)

2. Lunge (see poor stability on lead leg, back leg if weight shifts, and core if torso shifts)

3. Standing on one leg (see poor stability if cannot maintain foot flat and body straight)

4. One-leg calf raise (see weak peroneals/tibialis anterior, tight calf cause poor contraction)

5. Hip flexion on one leg (see poor stability with motion if cannot stand and flex leg)

6. Single-leg squat (see poor stability with motion if cannot bend with back, knee control)

7. Walking & Running Video Analysis!

PREHAB EXERCISES AND RESTORATIVE MEASURES:The techniques used to “prehab” these functional “weak links” include the following. However, often professional office corrective care (described in the treatment section) must be combined with the prehab. And the same techniques are part of our restorative measures to maintain, (“keephab”) our bodies for a season and seasons!

1. Active stretches to reduce muscle tightness in shortened muscles.

2. Foam and trigger ball rolling to release myofascial adhesions in all muscles, short and/or weak.

3. Muscle re-education and Core exercises to activate the inhibited muscles and strengthen the weak muscles in the legs, hips, lower back, abdominals and shoulder girdle.

4. Balance exercises to improve posture and stability in our kinetic chain from the foot up.

5. Multi-joint movement exercises /techniques to correct poor movement patterns and restore normal mobility.

PREHAB SPECIFICS FOR LEG, ANKLE, AND FOOT INJURIES: (Exercises in blue are either pictured or described in slides to follow). STRETCH: Gastrocnemius, soleus (rope/kneeling stretch)Deep foot/toe flexors, arch muscles/fascia (kneeling stretch)Ankle ligaments, ankle joint capsule (manual mobilization)Adductors, lower hamstring (rope)Piriformis/hip rotators (rope/supine , prone active )

ROLL: Gastrocnemius/soleus, arch, adductors, lower hamstrings, pirifomis, hip rotators.

STRENGTHEN: Full ankle plantar flexion, dorsiflexion. Tibialis anterior, peroneals, gluteus medius/maximus.. Use manual resistance, calf raise, elastic tubing, hip abduction/extension floor exercises. Progress to standing lunges, squats, and then to performing on unstable surfaces along with balance/stability exercises. Slanted board inner/outer leg “running” exercise. Sand hopping exercises.

ACTIVATE MOVEMENT PATTERN: Focus on Plantar flexion (pushing off straight “heel/midfoot” to toe in walking/running gait). One-leg calf raise, lunge on/off bosu-type apparatus.

BALANCE/STABILITY EXERCISES: one-leg standing, single-leg squat, rocker board, and same on unstable surfaces (half-foam roller, bosu). Stability ball leg extension, works muscles from the foot up to the hip.

PREHAB SPECIFICS FOR THE KNEE: There is no “cookie-cutter” approach, but there are certain common patterns that must be prehabed. (Exercises in blue are either pictured or described in slides to follow).

STRETCH: ROLL:

Hip flexors (lunge) Gluteals TFL, Hip FlexorsAdductors (rope) ITB, Vastus LateralisLower Hamstrings (rope) AdductorsCalf (rope) Lower HamstringsIliotibial Band (ITB) (rope) Calf

STRENGTHEN: Hip extensors, hip abductors, vastus medialis, deep core if weak, tibialisanterior, deep calf muscles (in eccentric contraction with slant board). Order of progression: knee isometrics/leg raises, abdominal bracing, prone hip extension, gluteus medius clam side-lying , bridge series, standing hip hike, quarter squats, slant board inner/outer leg “running” exercise.

ACTIVATE MOVEMENT PATTERN: Hip abduction, extension, end of knee extension. Same exercises as in strength.

BALANCE EXERCISES: one-leg standing, single-leg squat, rocker board, and same on unstable surfaces (half-foam roller, bosu, etc.). Stability ball leg extension. Lunge.

PREHAB SPECIFICS FOR HIP AND HAMSTRING:(Exercises in blue are pictured or demonstrated on slides to follow)STRETCH (active with rope) and FOAM/BALL ROLL: HamstringsPiriformisAdductorsHip Flexors (Rectus Femoris, Psoas, Sartorius)Tensor Fascia Latae (TFL)

STENGTHEN:Gluteus Medius with clam and bridge series.Gluteus Maximus with hip extension prone, stability ball leg curl, bridge and squat.Upper hamstring , core and gluteals with stability ball leg curl.Deep Core (transverse ab/multifidi/obliques) with abdominal brace, dead bug.

ACTIVATE MOVEMENT PATTERN:Hip Extension with standing knee hug, bodyweight squat, step ups.Hip Abduction with, bridge series, lateral mini-band walk.

BALANCE:Single leg standing, rocker board, challenge with resistance bands, lunge,single leg squat, bosu single leg standing, bosu squats.

PREHAB/TREATMENT OF LOWER BACK PAIN/DYSFUNCTION:

ACUTE STAGE: Reduce/stop training, ice to reduce spasm/swelling. Office treatment with electric stim., ultrasound, chiropractic adjustments/ manual therapy to get the tight muscles and joints moving again. Bracing if necessary. Only minimal “bedrest”. Pain relief stretches as soon as possible. Flexion or extension, depends on patient.

CORRECTIVE STAGE/CHRONIC PAIN: Continue manual therapy to correct muscle imbalances by releasing adhesions in key muscles and restricted joints. Continue pain relief strategies and start to stretch tight muscles such as hip flexors and hamstrings and activate weak muscles such as the deep core (transverse abdominus and multifidi) with abdominal bracing and the gluteus maximus with hip extension exercises. Use passive and active stretches, abdominal bracing and proper body mechanics in everyday activities to activate the core muscles and maintain motion.

REHAB STAGE: Continue corrective exercises, adding advanced core strengthening and stability exercises with dead bug series, bridging series, stability ball exercises, balance board exercises, and cable chop exercises. Add push-ups, pull-ups and functional weight-training. Fix structural overpronation with orthotics if necessary, use heel lifts for anatomical leg length inequalities, and and evaluate training program for your sport (running/triathlon).

SHORT –ARC KNEE EXTENSION: Activates and Strengthens VastusMedialis and Vastus Lateralis.Place 6-8 inch ball or rolled up towel under knee. Extend knee while focusing on contracting inner quad especially (vastus medialis). Hold 5 seconds and repeat.

Single-leg Standing: Looking straightahead, and in good posture stance, support your weight on the heel and ball of one foot for up to 30 seconds.Repeat with eyes closed. Failure occursif the foot touches the support leg, hoppingoccurs, the foot touches the floor, orthe arms touch something for support. If you lose balance restart and continue for a total of 30 seconds for each leg.

Rocker Boards: Stand in good posture stance and rock first with both legs, thenwith one. First rock front toback and then side to side. Forgreater challenge stand diagonallyin either direction andagain rock in both directions.Do 5-10 repetitions in each direction

Step-Ups: Stand next to a 6-8inch step or stool. Step up withinside foot then with outside foot.Step down with inside the outsidefoot. Relax and repeat for 2 setsof 10-15 repetitions.

Gluteus Medius Strengthening: Standing,raise the uninjured leg with the knee bent.Without bending the knee of the injuredleg, let your pelvis drop towards the uninjured side and then raise it by contracting the outer hip muscle (gluteus medius) on the standing, uninjured, side. This is a small motion but after 10-15 repetitions will fatigue a weak gluteus medius muscle. Work up to 2 sets of 20 repetitions.

DESCRIPTIONS OF EXERCISES LISTED IN PREHAB SLIDES BUT NOT PICTURED :

SEATED:

Manual ankle self mobilization- For your left foot , bend your left knee and place your outer leg on your right thigh. Bring your foot towards your shin (dorsiflexion), then place your right hand on the ball of the foot, and next push against your hand into plantar flexion as far as you can, giving resistance with the hand. At the end, switch hands and put your left hand on the top of your foot, and push against the hand back into dorsiflexion. Continue back and forth for 10 in each direction. Next, move the foot all the way up and in, then down and out, resisting with the right hand up and in, and the left hand down and out. Repeat with your right foot . This strengthens and stretches the ankle in a full range of motion.

Elastic tubing leg strength exercise- Use a theraband tied into a loop, around your midfoot of both feet. Sit with your legs straight out in front of you, crossed. To strengthen the inner leg muscles, bring the top leg’s foot upward and inward against the tubing. Do 10 reps, and switch legs. Next, to strengthen the outer leg muscles, uncross your legs, and push both feet out against the tubing simultaneously. (Make sure the band is tight enough to give resistance).

SIDE-LYING:Hip abductor strength exercises, “Clam-shell”- Lie on your side, with your hips flexed 45 degrees and your knees bent 90 degrees, and back perpendicular to the ground. Keeping your ankles together, raise your top leg45 degrees, opening at the knees like a clamshell. Be careful to move only at your hip and not with your back. You should feel the outer hip muscle (gluteus medius) working. The goal is to be able to perform 30 good reps for 2 sets.

SUPINE: Abdominal “bracing”- Lie on your back with your knees bent and feet on the floor, hands at your sides palms up. Without rotating your pelvis or “sucking in your gut”, contract your deep core and pelvic floor muscles by bringing your navel in towards your spine. To test if you are performing correctly, place your hands just above your hip bones- you should feel he muscles there tightening. Do not forget to breath- do not hold your breath! This may be difficult at first.

Bridge Series- Lie on your back with your knees bent and heels on the ground with toes up. Contract your core with the abdominal brace as describe above. Lift your hips and lower back off the floor until your are resting your weight on the heels and shoulder blades, with your neck relaxed. Hold the abdominal brace the whole time, and after 5 seconds lower your hips and back to the ground. Repeat 10 times. Your legs, hips, and back should remain in one line, with no tilting left or right. Advanced: lift into the bridge, and straighten one leg at the knee, hold 5 seconds and repeat with other leg. Super advanced: “Squat” on the one leg while in the bridge position, again not letting your legs, hips, and back tilt to either side.

PRONE:Hip extension exercise- Lie on your stomach, with a small pillow or rolled up towel place under your waist. Draw in your core with the abdominal brace exercise. Contract your left gluteal muscles and raise your left thigh and leg (with no knee bend) about 6 inches off the floor, hold 5 seconds and lower. Repeat 5-10 times and switch sides. Add theraband around ankles as you progress.

WITH STABILITY BALL: Stability ball leg extension- Sitting on a stability ball, contract your core with the abdominal brace and hold your shoulder blades down and back. Maintain your weight evenly on the ball and heel of the foot. Straighten your left leg, and maintain balance and posture . Hold 5 seconds. Return, switch legs and repeat 5-10 times each leg.

Stability ball leg curl- Lie on your back, in the bridge position on the stability ball. Keeping your deep core contracted, bring the ball towards you by contracting your hamstrings gluteus maximus, hold and return. Be sure to maintain the bridge and not let your hips and pelvis lower as you do the exercise.

STANDING:

Single leg squat- Stand tall with good posture, core contracted, shoulders down and back and arms at your sides. Lift one leg off the ground, bending your leg behind you. Squat down on the standing leg a quarter way down and return. You will bend at the waist about 30 degrees, but maintain your core contraction and resist tilting side to side. Your standing knee should maintain a straight line over your second toe as you bend and return. Do up to 10 reps each side and work up to 2 sets. Advanced: Add theraband under your foot.

Standing knee hug- Stand on one leg with good posture while bending the other leg to bring the knee up as close to the chest as possible. Contract the gluteals of the stance leg. You should feel a stretch in the glute and hamstring of the bent leg and the front (hip flexor) of the stance leg. Repeat each side 5-10 times.

KNEELING: Deep arch stretch, achilles/soleus stretch- Barefoot, kneel down on one knee on a padded surface with the toes of the other leg even with the down knee- this is the leg being stretched. The heel of this leg will be off he ground. Your hands should be at the sides of the knee and toes, palms forward as in a sprinter’s starting stance. Keeping your raised thigh at 90 degrees, lower the heel towards the ground, feeling the stretch in the arch, achilles and soleus as you lower the heel. (The heel will come close to the ground but won’t touch the ground).

SCHEDULING YOUR PREHAB INTO YOUR WEEKLY TRAINING:-Just fitting running or triathlon training into our daily lives can be difficult, so making time for the restorative measures (including sleep, by the way) can be difficult. Here are some suggestions for adding the prehab stretches, muscle rolling, strength, stability and movement pattern exercises to your daily, weekly, and seasonal routines:

DAILY: Stretch and roll at least your key areas in the morning, workout or no workout. Even just 5-10 minutes will help “set” your body for the day by stimulating the neuromuscular system to move properly from the beginning of the day. Also, take short one or two minute breaks from sitting at work, at least once an hour besides lunch, and stretch at your desk and take a brief walk around the office. (Search “Don’t Let Your Body Go Numb At Work” at www.abcnews.go.com featuring Dr. Bochner)

PRE AND POST WORKOUT: If you train after work, make sure you do the active stretches and movements to help transition your body from being sedentary to performing vigorous exercise. Also, two days a week add in the strength/movement pattern re-education exercises you need. They can be done by doing a few reps pre running and then full sets after, making time for them by cutting back on your easy run time by 20 minutes.

FITTING IN YOUR PREHAB SEASONALLY:

Off-season (winter) is the best time to re-evaluate your strengths and weaknesses, and he easiest time to spend more time doing prehab, movement pattern, strength, core and power exercises, as well as maintaining an aerobic base, possibly with other sports than running if you only run. Continuing the same intensity all year will lead to “burn-out”.

In-season, continue prehab, active stretching, and foam rolling of your key areas as above, paying extra attention to the days and weeks before and after key race and hard workouts, such as speed intervals and long runs and rides.

I

In summary, by “Preparing to Compete” with Prehab before training, and by getting treated with recovery care when muscles are tight and not yet injured or causing tendon/joint injury, injuries can be prevented and more time can be spent training and racing. Compare the old and new ways below:

INJURY CARE REHAB TRAINING & RACING INJURY CARE REHAB TRAINING & …

PREHAB & PERFORMANCE CARE TRAINING RACING RECOVERY CARE PREHAB &

PERFORMANCE CARE ……

Old way

New way

IV. VIDEO ANALYSIS OF RUNNING FORM:

SO WHAT DOES GOOD RUNNING FORM LOOK LIKE?

When we have normal muscle length, strength, and activation, and good movement patterns, then our posture both at rest and during activity will be improved and more easily maintained.

For distance running, our posture is called “running form”. Healthy running form demonstrates motion starting from our core , with rotation from the spine, through the hips/pelvis pulling our lower extremity back, while the opposite motion occurs from the mid –back up through the shoulders on the same side. Meanwhile the lower extremity contacts the ground with motion at the key joints- the knee bends, the ankle joint bends, and the foot lands lightly near the mid-foot and the arches flattening somewhat but not excessively to absorb impact and help propel us forward as they regain their height. The big toe dorsiflexes (bends upward) as we push-off. We are slightly leaning forward from the ankles, and not the waist- we are upright there and not bent forward. Above the torso, our shoulders and chest are upright, and the chin and head are over our shoulders. Our arms are bent slightly over 90 degrees at the elbows, and do not cross the body’s midline as we run.

Good torso rotation with elbows close

Poor torso rotation with elbows out