Teaching the Old Dog New Tricks.

We've all heard the expression, "Teaching the Old Dog New Tricks". I have found in my pursuit of Fitness, that this is essential to attain a high level of General Physical Preparedness (GPP). Having a clear definition of Fitness and understanding the physical components that constitute being Fit, will guide you to enhancing your exercise variety.

Crossfit is a great way to implement this. This all encompassing approach to fitness, brings with it, an extensive list of gymnastic, weightlifting, and mono structural (cardio) exercises, which will continually get you learning and refining skills.

I personally find the gymnastic movements most enjoyable, challenging, and also very physically demanding. The fun aspect of learning new skills, and the feeling of attainment, makes exercise engaging.

I currently set myself a weekly goal - to achieve a new skill. In the last two weeks, i have learnt how to hold a headstand, and perform a double under with a skipping rope. The hard work you put in to learning a new skill, is a workout in itself! The feeling of achieving the new skill, after a lot of endeavour, is a feeling you savour, and a feeling you want often. This is what fitness is about!

Injuries often make you change the focus of your training, and you have to explore other movements/exercises. Learning new skills whilst injured (ensuring that the skill isn't exacerbating the injury!) is a fantastic tool for maintaining positivity in a negative situation.

"New Tricks", not only increase physical capacities, but increase mental capacities. The brain like your muscles has the ability to adapt through training and increase work capacity, this is known as neuroplasticity. Learning "New Tricks" form new motor programmes in the brain, which allow us to perform these "New Tricks" from memory when needed.

The pursuit of Fitness should facilitate growth both physically and mentally. Learning "New Tricks", is a fantastic way to increase your GPP.

Learn a new skill every week for the next month, and see how you feel!

Flexibility/Mobility and Fitness

Who is fit? What is Fitness?

I was first introduced to Crossfit almost 2 years ago, from a fitness enthusiast perspective, my interest was immediately drawn in. What i appreciated, was and is, their definition of fitness, "An increased work capacity, over broad modal and time domains". Basically meaning, having a capacity to perform well in many different activities, over varying time durations. To be good at a wide range of activities (gymnastics, weightlifting, cardiovascular events), the individual must possess a number of physical skills.

Crossfit, identify 10 physical domains of fitness, that are fundamentals for being Fit (based on their definition of fitness): cardiovascular and respiratory endurance, stamina, strength, speed, power, agility, co-ordination, balance, accuracy, and Flexibility/Mobility.

Flexibility/Mobility is a massively important element in fitness, and is a common precursor to injury. Lack of compliance in soft tissue structures (muscles/tendons/joint capsules), can lead to injury, when trying to perform movements, that push past plastic limits (causing adaptive changes). This is seen in sprinting, racket sports, field sports, and other such sports. If soft tissue structures, and joints, become stiff, sporting performance suffers, as reduced range of movement, leads to reduce power production. This is commonly seen in Squatting - with stiffness in hips and ankles, and subsequent inability to control spinal midline in the descent of the squat, which leads to a poor bar path, decreased power output, and decreased ability to perform well.

Flexibility/Mobility for a lot of people is an untapped source of performance gains. It is also a fantastic fix for musculoskeletal pain, and a standard prescriptive treatment for all my patients. Flexibility/Mobility work is not just stretching, it is also self massage, for example, using a lacrosse ball for gluteal tension release, this will assist with hip rotational gains.

Being Flexible/Mobile, is an important physical skill to master, takes time and hard graft, to reap the rewards, but overlaps in to Performance - Squatting a PR, and Pain Management Strategies - Reducing muscle/joint related Lower Back Pain.

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Running Pain: The Crux of It. Part 2

In this part of "Running Pain: The Crux of it", Running Technique and Running shoes as Solutions to Running Pain will be discussed.

The Solutions:

Running technique - I prioritise this as the first port of call, when addressing Running Pain. As mentioned in Part 1, Heel Strikers have 3-5 times more loading on ground contact, and 7 times more transient loading, when the foot is in stance phase. A clear understanding of technique is crucial for running longevity. Adaptations should be considered if an extensive history of injuries, and/or a chronic isolated injury are reported. A general rule of thumb, that is documented widely, is that an individual who fore-mid foot runs, should on average have a cadence of 180 steps per minute. In my experience this can fluctuate between individuals, some are at 170, some are at 200. This is a good way to get Heel Strikers away from over-striding, which is a common cause of injury onset through braking moments on ground contact.

Running shoes - This is a massive subject in itself. Heel Strikers will generally opt for trainers with Heel Cushioning as a main feature. Fore-mid Foot Strikers will generally opt for less heel cushioned shoes with more flexibility, to work synergistically with their running technique. If we appreciate that cushioned running shoes with mid foot stability systems, encourage greater force impacts when running (increases risk of injury), dampen sensory input into the feet (increases risk of injury), encourage the heel strike (increases risk of injury), and also increase energy expenditure when running due to weighing heavier than their minimalist counterparts, it would seem reasonable, to consider this, an important Solution for Running Pain.

I would never encourage a Runner who has always worn heavily cushioned trainers, to change to a 5-Finger Vibram in one fell swoop. This is absolutely wrong, and makes me cringe when i hear patents's reports of this - no wonder your heel is on fire!!

In fact 5-Finger Vibrams, do state on the shoes, that Heel Strikers not use them for obvious reasons (There's no cushioning!). A sensible approach is one that a company called INOV-8 put forward -  a steady transition, from the heel to forefoot differential that you are accustomed to (12mm), to one that is less, but also comfortable and not causing adverse reactions. Heavily cushioned trainers have a heel to toe drop of 12mm, barefoot trainers have a 0mm heel to toe drop.

In my own personal experience a 6mm differential has been the best solution for me. Having a smaller heel to toe drop also encourages less of a heel strike, and facilitates Fore-mid foot Running Technique changes. To date i have purchased a fair number of minimalist trainers, the ones which i have found most comfortable and compliant are:


http://www.reebok.co.uk/mens-crossfit®-nano-2.0/J99800_580.html

http://www.inov-8.com/New/Global/Product-View-FLite-230-Black.html

http://www.inov-8.com/New/Global/Product-View-FLite-195.html?L=26&A=Fitness&G=Male


INOV-8 have a fantastic research section on their website that is worth a read.

http://www.inov-8.com/New/Global/Transition-Journey.html?L=26

http://www.inov-8.com/New/Global/Research.html?L=26


Running programme - Varied training is the key. As i mentioned in Part 1, most running injuries occur insidiously, due to the biomechanics inefficiencies with repetitive foot striking, causing structures to become stiff and fatigued.

The best way to prevent onset of injuries, or to rehabilitate form injury, is to introduce other cardiovascular modalities in to the training programme. Rowing, cycling, and swimming, will all keep the cardiovascular intensity high, and in turn maintain Running Stamina, but will take the "heat of the feet".

Varying distance, speed, inclination, time duration, running surface of run's is also a very good idea. Rest days in the week are compulsory, but on these days, mobility and strength and conditioning is allowed.


Mobility & Strength and Conditioning - This is the area everyone could do more! The underlying mechanism of a slow burning Running Injury is stiffness and/or weakness. Introducing Mobility work and Strength and Conditioning in to the training programme, can have a fantastically beneficial effect on short and long term goals.

In further posts i will talk more on Mobility exercises for Runners, and Strength and Conditioning exercises for Runners, commonly prescribed in clinic.

Let me know what your favourite Running Shoes are in the comments below. Don't forget to add me to your google+ to be notified instantly of new posts.

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Running Pain: The Crux of It. Part 1.

Running is generally regarded as the most popular chosen activity for people to exercise and achieve fitness goals. The most commonly reported reasons why people run is that is easily accessible, requires minimal planning, financial costs are minimal, and most importantly it's enjoyable and a very natural, human thing to do.

With an increase of runners over the last decade, there has been an increased level of people with running related injuries. The amount of literature that circulates nowadays with regards to running and matters related is vast, which in my opinion is fantastic. Knowledge is power! I much prefer looking after patients who come to me with informed mind sets, so there is a baseline of understanding, before the jargon of the practitioner begins.

I like keeping things simple. Albeit in my profession, there is a tendency to complicate, which i feel is based on the amount and variety of evidence based information we use to treat patients. I would like to put down my thoughts and ideas of running, and running pain, and where it can go wrong.

Feet health, and awareness of your feet is so important. Like our hands, they are a massive source of information about our surroundings. In a fully fit, pain-free individual we don't give our feet much thought, we put our feet in the chosen shoes for the day and get on with life. This is a very habitual thing that we were taught from infancy, and evolves in to a fully set autonomic behaviour. The functional sensory awareness of our feet compared to our hands, day to day is less, for obvious reasons. Our hands are multi-task appendages, which require a fantastic amount of cortical activity (think of all the activities of daily living), and our feet are mainly used for standing upright, and locomotion (i'm sure people can do some party tricks also with their feet).

Foot function and the shoes we wear (which dampens feet sensory input), leads to a general lack of conscious thinking about feet when it comes to running, and running pain. We become somewhat desensitised to the importance of what are feet are doing when we run. "It's just running! Why do i have to think about what my feet are doing?" This a common thing i hear. But what your feet are doing is where the magic happens! The following sub categories aim to condense the correlate factors associated with running and running injuries, which i have gained form experiential evidence.

The Runners:

The majority of Runners that present in clinic share common behaviours. Most have been to the trainer shop, and had an assessment on the treadmill, been prescribed anti-pronation or neutral cushioned trainers for over-pronated or neutral feet respectively. However this expensive process, which seems to be the default, hasn't stopped the onset of pain.

Some of the Runners who possess better self management skills may have self prescribed orthotics, or sought a Podiatry assessment, but they still present with pain.

Most of the Runners i care for, just Run. There are no other modalities of exercise in the week at all. The Running programme is also very unvaried, e.g. "I run 5miles, 3 times a week", or "I run just on the weekend because i can't fit it in to the week, i manage to hit 20 miles".

Some who have better self preservation instincts may have rested for a few days/weeks/months, and then returned back to their usual running circuit/distance/speed, but the pain at some inopportune moment returns.

The scratching of the head follows - "I've had the treadmill assessment, and i've got the trainers, I've invested some hard earned money in to this!, surely the amount of money i've put in to this means i'll be injury proof", "I've also rested", "And I've also put these orthotics in my trainers!". "Why am i still getting pain?, "What else is there?". (This is addressed in Solutions).

Presentations:

The majority of cases i see in clinic are unilateral (one-sided) problems. Runners do get bilateral issues, but i'm speaking from my own clinical findings. The following are a list of the issues that are commonly found, from the big toe up:

Hallux Limitus.

Metatarsalgia.

Pes Planus (dropped arches).

Tibialis Posterior Dysfunction.

Plantar Fasciitis.

Achilles Tendinopathy.

Shin Splints.

Patella Tendinopathy.

Patella Mal Tracking.

Ilio-Tibial Band Syndrome.

Sacro-Iliac Joint Dysfunction.

I've listed the conditions from the big toe up, because big toe function (1st Meta-Tarso Phalangeal (MTP) Joint ) is absolutely crucial for efficient forward propulsion (Windlass Mechanism). If we lose mobility of this joint (Hallux Limitus) due to ground reaction forces imparted, during walking and running, it can in turn have an upstream deleterious effect on joints and soft tissue. I regularly see Hallux Limitus in clinic, which normally isn't the reason the patient has attended, more often than not, they have attended for one of the pathologies (Achilles Tendinopathy/Plantar Fasciitis/Ilio-Tibial Band Syndrome) in the list aforementioned.

Hallux Limitus is highly correlated with increased ground reaction forces when in locomotion. High ground reaction forces are seen in Runners with weak, dropped arches, and subsequent lack of pronation control. Additionally, a short or long big toe (1st Metatarsal Shaft) in relation to the second toe, can also predispose Runners to Hallux Limitus, due to impaired 1st MTP function.

If you've had or have, one of the listed problems listed, check your big toe extension on that same side. You may find that you have a limited range of movement, compared to the other limb.

Very simply, when Running, if ground reaction forces are high, and anatomical adaptations over time occur due to stress, our biomechanics, in turn, become dysfunctional. This dysfunction, appears as pain, and takes refuge within our joints and soft tissue structures.

Following on from Runners just Run, in the Runners section, and feeding in to the next section on Running Technique, Runners that frequently run 5km - 20mins/10km - 40mins/26miles - 3hrs, are respectively achieving 3600, 7200, 32,400 foot steps/strikes (based on 180 steps per minute (90 each foot)). If Runners just Run, and strike the floor thousands of times, so many times a week, with dysfunctional mechanics, problems will appear.

The Science and The Spiel.

Running technique is everything. When considering ground reactions forces, anatomical adaptations, and injuries, running technique is the biggest piece in the puzzle. If your symptoms are acute and you can hardly walk, it might not be the first thing you address when seeking medical advice, But fundamentally, identification of how you run, and its relationship with your presenting injury is key.

There are two types of Runners: Heel Strikers and Fore/Mid-foot strikers.

Normally the Heel Strike Runner's first point of contact with the floor when running is the heel, followed by the ball (head) of the 5th Metatarsal, followed by the ball of the 1st Metatarsal, then the foot leaves the floor with end of the big toe being the last point of contact.

Normally the Fore/mid-foot strike Runner's first point of contact is the ball of the 5th Metatarsal (or slightly behind), followed by the ball of the 1st Metatarsal, followed by lowering of the heel, followed by propulsion off the floor, with the end of the big toe being the last point of contact.

The majority of "Broken Souls" I treat are heel strikers.

There has been an increase in the volume of clinical research on human kinetics (human movement), kinematics (movement at specific joints), and ground reaction forces of running, over the last few years, and there have been some interesting findings.

Studies have revealed that heel strikers have 3-5 times more loading in the foot (heel bone) on ground contact in comparison to fore/mid-foot strikers. In addition the transient loading of the foot when in contact with ground is 7 times greater in heel strikers compared to fore/mid-foot strikers (Lieberman et al, 2010). This is pretty convincing/concerning, and from my point of you, as a therapist, a significant factor that needs addressing.

If you look at the foot from an anatomical viewpoint, it also makes a lot of sense if you land on the widest part of the foot (the forefoot), as this would inevitably experience less pressure (compared to the heel bone) due to a greater surface area. Additionally the forefoot splays on ground contact, which a fantastic property for the spreading/dissipation of weight.

When comparing the techniques of the two running styles, there are stark differences. The main thing for me is that the Heel Striker commonly lands on the heel with a straightened leg, compared to the Fore/mid-foot Runner, who lands on fore/mid-foot with a flexed knee. The flexed (bent) knee will have less leg stiffness and handle forces a lot better, but will also be in a better position when the foot contacts the floor, to propel forwards. The straightened leg with the Heel Striker, will encourage a braking/deceleration moment, which reinforces attenuation of shock, and impair efficient forward propulsion. This is very apparent in fatigued Heel Strikers and Over-striding, one of the biggest injury drivers.

Other valuable areas of interest when dealing with running injuries are trainer cushioning and running surfaces. Very simply running trainers historically have focused on heel cushioning, as it was assumed the majority of Runners were heel strikes, and the cushioning gave Runners comfort, and in turn also facilitated and reinforced the heel strike (am important point to note). Research has postulated that heavy cushioning in trainers can actually cause the Runner to strike the ground with more force, mainly to try and get some information in to the foot, due to the sensory dampening, but also as the Runner knows that the foot is safe from harm. This can lead to increased force impacts through the lower limbs, and weakness development in the intrinsic foot muscles of the foot, due to reduced activation when Running, which can increase the incidence of pain.

Running surfaces can be looked at as a possible means of injury occurrence, and a potential adjunctive solution to running pain free. Most people report that running on softer surfaces is better for you, as it reduces force impact attenuation through the lower limbs, and the opposite when running on harder surfaces. I understand the commonsensical approach here, however i see it in a different way.

If you jump on trampoline, do your legs instinctively stiffen up or do they relax? They stiffen up, and this is what your legs do when you run on softer surfaces. Increased leg stiffness can be correlated with injury onset, and this is also exaggerated with Heel Striking. Running on harder surfaces incurs less leg stiffness and in turn less stress through the system. In addition harder surfaces are normally constant level surfaces, which facilitates a better running rhythm, and this is also an important factor to consider. The jury is out with Running Surfaces, and the decision to opt for road or grass is an individual preference, we can only make informed decisions.

In Part 2, I will talk about Solutions to the points highlighted, and what i advocate in Clinic.

Injuries and Ownership - The "Broken Soul".

Unfortunately we have a capacity to break, many of us think it will never happen because we are the special ones, and this is where we go wrong.

There are many ways we can break, i use the analogy of little hammer and big hammer:

1.) Little hammer taps away at the body for weeks/months/years, this may be frequently felt with landing foot when running, or when creating front rack in cleans. Whatever the movement pattern that causes the little hammer to tap away, if no adaptation occurs, breakages occur.

2.) Big hammer happens in one fell swoop, this is either lifting too heavy with incorrect form (the deadlift is one of the main culprits here), sprinting from the blocks (warm up? underlying unaddressed issue?), a big collision in a field sports (this can be a case of wrong place, wrong time. However post match reflection can sometimes question body positioning?).

The "Broken Soul" is born (this sounds very deep!), when one sustains injury. Regardless of the little hammer, big hammer analogy (the causative factor), a breakage has occurred. How quickly the pieces are glued backed together depend on a number of factors. The severity of the injury dictates the duration of recovery, big hammer injuries commonly require longer lay offs, little hammer injuries, if picked up quickly, tend to rehabilitate a quicker. If little hammers are picked up late, these can sometimes be just as long or even loner than big hammers, due to adaptive/compensatory changes in the system.

In my previous post, i mentioned about getting a precise diagnosis, targeted treatment, and structured rehabilitation regimen. This is vital to get on the right track. What i have found with my clinical experience to date, is lack of ownership, and subsequent negative mood states, can have an overwhelming affect on recovery time, if not addressed early on. This can lead to the rapid evolution of the "Broken Soul".

The "Broken Soul" is a powerful, overriding, stubborn person who grunts to communicate, starts to skip their daily shower, and doesn't seem bothered that their coffee machine has needed descaling for the last 2 weeks. This lack of energy and adherence is part of the grief response, and can portray itself in the clinical setting, as lack of compliance and negative expectations. Acceptance (which is one of the stages of the grief response) of the injury, which for some people is a difficult process to achieve, is vital for efficient rehabilitation. This is synergistic with ownership of the process, ownership walks hand in hand with acceptance.

Acceptance and Ownership is what fuels the positive transition of the "Broken Soul" to the "Harmonised Soul". The "Harmonised Soul" is the target, and to have precision in achieving this, you need to have OWNERSHIP of your recovery, dictate the terms (with the guidance of your physiotherapist), and then your adherence to the rehabilitation regimen will be optimal.

Maintaining Motivation Whilst Injured.

It's easy to lose focus when injured. I speak from personal experience, but also through observing and treating my patients. The main thing that i have found, is that the training program is either totally forgotten about, or only used marginally as a fleeting effort to maintain some kind of structure. Injuries can be acute or chronic, but the impact on the program can be similar in intensity in the short term, however have a different impact in the long term. My main focus is on the chronic injuries, the people in the late 20's+ cohort, who have used and abused their bodies through sport and fitness, harbor niggles, and if not managed well, develop injuries, which sideline for period of time.

Seeking out a health care professional, getting a diagnosis, and prognosis, receiving treatment, and implementing a rehabilitation protocol is a fantastic start. During this period the training program may cease if the injury is very irritable, or may be modified to take the focus away from the injured site (if possible), but there will be a significant effect on the training program. This in itself will cause frustration, anger, annoyance, feelings which are all very negative, but unfortunately a very human response to injury and the impact injury has on routine. Routine is something all fitness enthusiasts share, as fitness becomes habitual and part of one's lifestyle, we hate change, we hate stopping, but once we've accepted the injury, and impact the injury has had, we can then start planning the future training plan.

The motivation that was affected through injury, comes back pretty quickly through physical therapy, having a prognosis and realistic timeframe of full recovery, abstaining from aggravating movements whilst rehabilitating, and having never lost the training program. The training program should always be active, even if cessation from activity for a week or month due to the injury has to be enforced, planning for return to activity should be implemented. A clear idea/plan for return to training is vital for focus and motivation, and the return plan should be modified according to injury restrictions and fitness levels at that time, you won't be as fit as you were pre injury, so don't expect to lift or run your PR's your first session back.

Don't forget from week 1 to week infinity, you need to make your rehabilitation exercises a staple part of your training routine, there's a reason why your shoulder gave up on you! Movement restrictions, postural dysfunction, and weakness led up to the problem, so in order for you to overhead squat, make sure you do the basics or you'll be back at square one! This is the best way to stay healthy, prevent injury, maintain your training program, and maintain motivation!