Run Stronger & Longer While Staying Injury Free

Today, we have guest blogger, Chris Kaplanis, co-owner and coach for Ridgewood TriAthlete based in Ridgewood, NJ writing about running form and technique!

Learning and practicing proper run form and developing run economy will serve all endurance athletes well.  Beginner to professional – this is one of the best ways to run stronger and longer while reducing the risk of injury. 

Most athletes new to the endurance arena, namely runners and triathletes, overlook or discount the importance of learning the fundamentals of running.  I suspect this may be the case for several reasons, but quite simply, humans are land animals.  When we want to run, we run.  Unlike swimming, where proper form has a major impact on forward movement and successfully swimming, you can easily fudge running for at least a mile or two.

While running a couple miles is great for most people, if endurance events (10k, Half Marathon, Triathlon, ect) are what you’re interested in, the first couple miles are usually just the warm up.  As athletes train to run longer and/or faster, form and economy play an increasingly important role.

And remember, run related injuries affect 60-65% of runners each year and are by far the most common among endurance athletes.

Below we will go through the basics of proper run form as well as touch on 3 vital components of improving your run economy.

Proper Run Form & Economy

The biomechanics of running is the form component of running and good running biomechanics improves speed and helps prevent injury.  Proper form enables running to be more enjoyable and helps improve your economy allowing you to run longer and stronger while helping to reduce the risk of injury.  In other words, proper run form and economy will increase your body’s “miles per gallon” allowing you to go further using less energy.

Runner’s World has a great introductory breakdown of Perfect Run Form, which is a great place to familiarize yourself with how you should look.  However, knowing how you should look and how you actually look is where a coach or friend can be a big help.

A few items I’d like to point out that the Runner’s World article doesn’t quite touch on include where your feet should fall, cadence and vertical oscillation.

Where do your feet land?  Your foot should land underneath you as opposed to out in front of you.  By landing each foot fall under your center of gravity you will naturally be more like to land on the forefront of your foot.  The forefront of your foot is between your toes and heal, specifically right between the “knobs” of your foot.  This is the ideal place to land.  By landing here your body will absorb the force exerted on each leg much more efficiently.  If you only run a few miles a week you may never experience the consequences associated with heal striking, however, as you increase your mileage the risk of injury goes up.

TEST 1: Jump straight up in the air, about a foot off the ground, and land on your heels. OUCH! This is essentially what your body is absorbing with each stride you take when running if you’re a heel striker.

TEST 2: Take off your sneakers and try running 100 yards.  You’ll probably notice that you naturally land on the forefront of your feet as you run; absorbing the force your body creates quite nicely. NICE!

Additionally, as a heel striker you’re essentially putting on the breaks each time your foot lands.  Think about this for a second… if you run this way, each time your foot hits the ground your heal digs in and essentially breaks or slows a lot of the forward movement you’ve created.  Not only that, but instead of going instantly into your next step you have roll from your heal to the forefront of your foot to push off for your next step forward.  Needless to say, this is not very efficient.

What is run cadence?  Run cadence is the number of steps per minute an athlete takes while running.  Cadence is typically measured by the number of times ONE foot hits the ground over a minute.  Similar to cycling cadence, as you run, you should strive for a cadence of about 90.  You may have noticed many elite marathoners appear to float along as they run, barely touching the ground and at a cadence in the high 90’s this is no surprise. 

Run cadence is important for a couple reasons. 

First, the higher your cadence the less amount of time your foot is on the ground.  The less time your foot is on the ground, the less impact your body absorbs with each stride.

Second, cadence is the same as stride rate and stride rate multiplied by stride length equals speed. 

Stride Rate x Stride Length = Speed

Most untrained athletes run at a cadence of about 80.  Anyone can have a high cadence when sprinting or running fast, but most cannot sustain that pace.  The trick here, is learning to increase your cadence (or turnover) when running slow or at a comfortable pace so that your heart rate does not spike.  This takes practice and patience, but if you are diligent it WILL PAY OFF.  Not only will your body thank you, but if you can increase your cadence by 5 while holding your HR steady, you’ll be able to knock off 2 minutes (or more) over 10k (6.2mi). 

You can easily check your cadence by counting the number of foot falls over :15 seconds and multiplying that number by 4.  Manually counting is a great place to start, but I often find this to be a misleading way to check your cadence.  When athletes count their steps manually, more often than not they’ll hit the target of 90 even if they’d normally never come close.  As a result, I do believe this is a good method of training yourself to run at the proper rate, but in terms of checking and monitoring cadence I prefer using Garmin’s foot pod, which counts for me.  This way there’s no cheating.

Another great tool to use while learning to run at a 90 cadence is a metronome.  You can set the device to beep at 180 beats per minute.  Each beep will represent a foot fall.  I recommend running with it on first a few times and then alternate turning if ON and OFF throughout your run to “check in” to see if you’re holding a 90 cadence.  Remember, it is important to practice this while running at a slow comfortable rate.  You must avoid increasing your pace in order to hit the proper cadence.  The more you practice, the easier it will become.

What is vertical oscillation?  While watching people run it is not uncommon to see athletes run with a bounce or spring in their step/stride.  Vertical oscillation is the up and down movement that occurs with each stride.  While everyone will “bounce” slightly while they run, the goal is to reduce this as much as possible.  Too much bounce, wastes energy and decreases the distance forward with each stride. 

You can help reduce your vertical oscillation by trying not to lift your knee so much when running.  In order words, all your energy should be behind you, not in front of you.  Fellow USAT Coach, Kelly Wisolik does a great job at explaining this below.

“Lifting versus pushing is the concept that is better described as “muscling versus springing.” In distance running, an athlete does not want to “lift.” Lifting means “launching.” This involves a lot of muscular use as it requires power and strength to lift and launch forward. It’s good for power running like football and basketball players and track sprinters. But this extra energy expenditure is not advantageous for distance runners and triathletes. Lifting pulls the chest up and not only uses more muscles but more oxygen too! Lifting occurs when the stretch-shortening cycle is not effectively being employed during the running stride. Pushing is the idea of pushing off the extended leg during the running stride. Pushing is an effective use of the tendons and momentum. Dropping the knee, leaning forward and springing from extension engages the natural reaction of the Golgi Tendon. This conserves muscles and oxygen and therefore is good for distance runners and triathletes. This is the concept of “dab and push forward,” “drop and spring” and “lean and push” which reduces power loss unlike “lift and pull.””

While the description above is well written, sometimes is best to just pretend like you have a glass of water (or wine) on the top of your head and you’re trying not to let it spill.

Be Smart

Many athletes find it invaluable to seek out a local coach to take a look at your form (swim, bike and/or run) and help correct it.  Clinics offered by local run/bike shops and triathlon clubs are another option. Whether you’re looking to improve your economy and make you a little faster or if you’re mostly concerned with injury prevention, working on proper run form is well worth the effort.

Written by: Chris Kaplanis, Ridgewood Tri Athlete

Chris Kaplanis is a professional triathlon coach.  He is the Managing Director & a coach at Ridgewood Tri Athlete, a multisport coaching business and tri club located in NJ.  You can follow Chris on Twitter @ChrisKaplanis.  Find out more about RTA on Facebook: www.Facebook.com/RidgewoodTriathlete and on Twitter: @RTA_Nation.

I thought swimming was a "safe" activity? Part 1: Common Shoulder Injuries in Freestyle

Well, if you swim like your grandparent, then maybe.

When people think of swimming, thoughts of vacation and leisure tend to come to mind.  Such a gentle sport, or so you thought!
For the competitive or novice swimmer, the prevailing region of the body we treat is the shoulder.  In this blog, we'll be discussing the causes and solutions to help your shoulder pain while you swim.

What are the causes of shoulder injuries in swimmers?  As noted in the picture above, one of the most common stroke flaws resulting in shoulder pain occurs when the freestyler's hand crosses the midline of the body as the hand enters the water (should be in line with shoulder, not directly above the head or over).  This flaw is usually caused by an overrotation of the body and over time, can result in impingment of the shoulder, which is pain near the front or side of the shoulder when raising the arm to the front or side of the shoulder.  In addition, if the swimmer's core is not engaged particularly during breathing, that same overrotation of the body can result in the bottom hand drifting pass midline, causing more stress on the shoulder when the catch phase of the stroke is initiated.  Biceps tendonitis and rotator cuff tendonitis can also result from this type of hand entry into the water.  Another cause of shoulder pain occurs when a swimmer uses a straight arm pull instead of one with a bent arm, again causing a great deal of strain over time in the shoulder. 

Easy solutions-
-point it out to the swimmer!
-swim drills with hands at the 1 o'clock and 11 o'clock positions, aka, "superman" glide (should be able to see your hands in the periphery of your sight)
-work on hand entry, vertical forearm, and bent arm pull drills
-core drills in the water to keep your body in balance

Why DPTs Should Embrace and "Practice" Fitness

As you all know, Maven has always been about bridging the fitness and rehabilitation gap.  Although a steady number of rehab professionals are becoming like-minded, the vast majority of doctors of physical therapy continue to focus on addressing physical impairments or functional limitations through very rudimentary exercises and not the kind of functional strengthening that we, as the musculoskeletal experts, should really be incorporating into our plan of care. We seem to be stuck on exercises like biceps curls, mini squats, and straight leg raises; don't get me wrong, these exercises certainly have their place in the early stages of recovery, but need to be progressed before discharging a patient.

Simply put, patients separate rehab exercise from fitness or "gym" exercise as they are often not challenged enough by their rehab exercises and are looking to their personal trainers for a real workout, when in fact, fitness or strength goals and activities could easily have been weaved into their rehab visits with a physical therapist.

Why aren't more DPTs using the TRX suspension system or kettlebells instead of cable machines?  I thought that our profession has always been about restoring functional movement and strength?  Why isn't the Concept 2 rower a normal mainstay in all rehab facilities?  Are we still relying on passive care such as, ultrasound, joint mobilization, a quick rubdown, and e-stim?

If we, as DPTs, are truly concerned about wellness and prevention, which we tout in our profession, then why aren't we educating ourselves and our patients by discussing weight management, nutrition, and fitness?   Is it because we don't prioritize the after-care of our patients or are fixated on manual therapy?  The overall goal is to restore pain-free functional movement and prevent injury, as I wrote earlier.  If that's the case, then we should be offering sound advice and direction on how to achieve fitness goals in the safest, most efficient, and most effective manner.  Doesn't nutrition and food intake have a direct effect on healing, reducing joint stress, and pain reduction?  Doesn't creating a fitness plan transition towards discharge help our patients prevent injury and help reduce the burden on the failing healthcare system?

Physical therapists are one of the best positioned medical professionals to address movement impairments and provide safe and effective recommendations on exercise and weight management.  It's about time our profession steps up to the plate and fully embrace fitness as part of the rehab continuum...or else other professionals will continue to take it on and leave us in the dust with our ultrasound, e-stim, and passive manual techniques.

Why burpees are an essential clinical tool....

Yes, we love/hate them, and we know that you do, too.  Burpees.  Whether they're done with a chest-to-floor push-up at the bottom or a clap in the sky at the top (or both!), burpees are an envogue fitness activity for conditioning purposes, and they just never seem to get that much easier....no matter how fit you are...

Clinically, burpees(aka squat-thrusts, aka "M"urpees) can give us some valuable information about how our patients are faring during the plan of care. Would we use them on every patient we treat? Probably not, but for those patients who live an active lifestyle and want to return to their favorite activities post-rehab, they will find themselves doing burpees at some point during their stay at Maven. As one of Maven's key clinical movement assessment (and treatment) tools, burpees can be used qualitatively and/or quantitatively to:

1. assess a patient's healing progress after they've passed the subacute stage of an injury
2. provide clinicians with a general "clearing test" prior to discharging a patient
3. determine if a patient is ready to be progressed to more dynamic activities or return-to-sport
4. assess gross and regional dynamic joint and segmental stabilization in a closed-chain position (the most functional position for most everyday activities)
5. assess the general status of a patient's or athlete's muscular endurance and conditioning
6. reveal other areas of the body that may need to be screened and evaluated for injury prevention.

Key areas of closed-chain, dynamic stabilization and/or mobility are assessed at the:

• cervical spine
• scapula
• thoraco lumbar region
• lumbo-pelvic region
• hip
• ankle
• wrist
• knee 

The video below shows Dr. Lee explaining how to perform a standard burpee (sans claps or push-ups in this video). Hopefully, you can appreciate how much mobility the wrists, shoulders, hips, knees, ankles must have in order to execute the exercise correctly. Also, notice how the scapulae and trunk("core") muscles have to stabilize the body in motion during the burpee as well.

If a patient comes to us with a wrist injury, for example, and needs to return to competitive gymnastics, multiple repetitions of burpees should be able to be performed with ease before any kind of floor or beam routine can be resumed.  If a patient has pain during a burpee in the lumbar region, most likely, lumbopelvic stabilization is not adequate to keep the spine from overextending, so we need to work on this more to clear the spine.  If a patient bends more at the back and less at the hip when they squat down for the burpees, we know to look more closely at the hip and pelvis as a potential movement limiting factor that needs to be addressed.

These are just a few examples of how burpees can assist rehab professionals during their physical assessment of the active patient and progress them to a successful return to their fitness goals! 

Stay tuned for videos on our Youtube channel providing more insight into our clinical movement assessment tools!

What's triggerpoint dry needling?

Trigger point dry needling is an effectively used modality to treat musculoskeletal pain. Licensed healthcare professionals including doctors of physical therapy have been using dry needling all over the world including the United States.

Maven Sports Medicine has been at the forefront of pushing for rules and regulations in New Jersey to permit the use of this treatment modality, which finally received NJ State Board approval in 2011. Yes, as you all know, we like to move and shake. Obviously, there is contention with the NJ acupuncture state board, who claims that it is indeed "acupuncture" what we are doing, however, allow me to explain some significant differences (btw, I still refer patients out for acupuncture, if that clarifies the picture):

Acupuncture 
Acupuncture requires state licensure, 4 years of education and/or a masters degree.  Training includes extensive knowledge and application of eastern medicine, anatomy, which includes the meridian system, and herbal medicine.  The pulse (there are three in eastern medicine) along with the history and other clinical and subjective measures are used to determine where systematic, energetic dysfunction may lie, and intervention via acupuncture needles, herbal medicine, or acupressure is employed.  For example, back pain may be a result of stagnation or surplus of energy, "chi" in a particular meridian, and needles may be placed in a region away from where the pain appears to be located. 

Dry needling 
 A systematic method of addressing localized trigger point muscle pain using dry needles (that is, needles that do not have medication, developed by Travell and Simons, MD in the mid to late 1900s. Trigger points in muscles result from overuse, disuse/weakness, or (traumatic) injury to muscles.  Posture-related injuries also can lead to trigger points.  Palpation of the muscles or regions involved is performed with the goal of eliciting a patient's symptoms (whether localized or away from the region palpated), a "twitch" response, or "taut/ropy" bands of the muscle. 

Dry needling can also be used to treat long-standing tendinitis or old muscle tears/strains by bringing about a relatively "controlled" inflammation response to initiate the cascade of physiological responses necessary for tissue healing, as an adjunct to other physical therapy modalities.  Applying dry needling or "TDN" requires extensive knowledge of surface/musculoskeletal anatomy, of which DPTs are experts.  Keen palpation and joint assessment (as well as other components of our comprehensive evaluation) are also necessary skill sets, which we practice and use daily to determine where musculoskeletal injuries may be emanating from.

Dry needling, therefore, is absolutely within our physical therapy scope of practice, and I would never call it acupuncture- this would be an insult to the acupuncture profession and all the training that a licensed acupuncturist must go through.

What to expect
Patients often describe transient discomfort, particularly when a twitch response has been elicited.  Following a dry needling "session", we often have patients perform a few gentle active range of motion exercises to further the effects of the needle, ultrasound to relieve dry needling symptoms, and electrical stimulation with ice as well.  Discomfort or pain resulting from dry needling lasts for about 1-2 days on average and icing or over-the-counter NSAIDs can be used. After a few days, many people (especially if we target the right spot) report moderate to significant relief of their pain.  It's pretty amazing, actually.  We've used it on our everyday computer user to our elite athletes and have had good results, thus far.  Obviously, dry needling is not a panacea, or I'd be living in Fiji with my fam right now, but it does offer another way to help you get back to your activities.

Diagnoses
We have treated diagnoses including (cervicogenic) headaches, IT band syndrome, tennis/golfer's elbow, rotator cuff strains, Achilles tendonitis, neck and low back pain, hamstring and quad strains to name a few ailments. 

For more information on how dry needling may help you, contact us via email at mavenoffice@gmail.com or jerrymaven@gmail.com

Feed Your Injury

Having been in the field nearly 12 years, patients are often wondering what exercises or activities they should be doing at home or avoiding to help accelerate their recovery, but no one really asks,

"Is there anything I can eat or take (that is legal, of course) to help this injury get better?"

There is SO much one can do. 

Setting up the substrate-
our bodies exist in a relatively alkaline state (higher pH or more on the basic side of the acid-base scale).  Musculoskeletal injury causes localized inflammation in a particular region.  Inflammation is GOOD and NECESSARY for healing.  We just want to CONTROL the inflammation so that scar tissue is laid down in the injured area in a more organized fashion instead of one that is haphazard.  We also want to get better quicker, don't we??

So, in order to improve healing, do all that you can to minimize foods that might tip the scale towards inflammation. 

What does this mean?  Are you saying that foods can cause or increase inflammation?
Yes, of course, and you probably already know the macronutrient types that do. Read on-

Foods to eliminate or drastically reduce from your daily consumption (at least while you're healing from an injury or post-op surgery:
-Refined carbohydrates (breads, pastas, white rice, refined sugars) 
-Processed foods
-legumes (yes, a gray area that needs more evidence)
-For many reasons, cutting out these poor sources of carbohydrates will not only benefit your recovery, your waistline and body composition will improve. 
-Dairy (cheese and milk. Eggs are ok).
-Red meat (this is kind of a gray area as there are clear benefits to eating grass-fed red meat including creatine, BCAAs, etc).

Foods to add in or dramatically increase in your daily consumption (at least while you're healing from an injury or post-op surgery (this is by no means a comprehensive list, but will start you off in the right direction):
-Water, water, water- muscle is ~75-80% water.  Does drinking enough water/fluids make sense? During an injury, consider drinking alkaline water with a pH that is 8.0 (Eternal and Iceland spring are brands that I've consumed). 
-whey protein isolate (somewhat controversial since it's processed, but it's known for rapid and nearly complete absorption into muscle tissue.  For vegans, pea/brown rice protein are good alternatives)
-Omega 3 sources:
nuts (unsalted)- particularly almonds, walnuts
chia seed
salmon
avocados
veggies: purple, red, yellow, green
-substitute quinoa for grains (quinoa is a seed).

Obviously, your body has mechanisms in place to keep itself in homeostasis, but we can take an active role in helping our bodies minimize the energy needed to maintain this, ESPECIALLY when an injury is present.

Another temptation active folks face when side-lined during an injury is to reduce caloric intake.  My question back to you- If your body needs X number of calories to function at a certain level per day, do you think that reducing your caloric intake will assist or lengthen your injury progression?  I think the answer is obvious.  Remember, in the grand scheme of things, stabilizing your food intake won't put massive pounds on you (unless you eat poorly to begin with). It can only help, especially if you're feeding your injury the right things as we mentioned above.

Having said that, if you have any questions or concerns (there are almost always exceptions to every rule), send us an email!

The Maven approach to a successful multisport season- Part 1

What's our training philosophy here at Maven?

You all know from Mavenaction (mavenaction.com) that we believe health has to come first.

So, what is health?

Well, generally, we believe that there are 4 major components- physical, mental, emotional, and spiritual. Any strain or pull in one of these areas diminishes the effectiveness and overall state in the other areas.

For this blog's purpose, we'll be emphaszing the physical-

Fitness is, first and foremost, a major constituent to the foundation of general physical health and wellness, which allows one to take on any sport or athletic activity to a maximized level of performance. When we talk about fitness, we must also understand that "clean" nutrition gives fitness the necessary fuel to attain that level of performance. Sleep, rest, and recovery are also well infused components of being more healthy.

Put it this way, how can you even think of having your best race in your respective competitive sport (not exclusive to multisport) when you haven't sufficiently trained ALL of your body's energy systems, incorporated functional strength training as well as flexibility acquisition/maintenance and balance work (let alone managed a solid nutrition plan, recovery, and rest training) ?

Are you fit just because you can do an Ironman? Many people think so, but this is definitely not the case. You've seen them before- the skinny fat athletes, the overweight athletes who are very good at enduring, but have high, double-digit bodyfat.

From my own experiences competing in multisport endurance activities for the past 13 years, I can say for sure that aerobic conditioning (cardio) are merely one facet of fitness, but by no means do they complete the palette. I am faster (and fitter) at 37 than I was at 27. I have been PR'ing every race I've done this season since I really began to take fitness more seriously as part of my tri-training with Mavenaction and crossfit endurance, while my triathlon training volume has decreased....and continues to decrease. I have to admit, while the science supports this way of training, mentally/emotionally, it hasn't been easy...and, to be honest, tri-training is usually more fun than cross-training (don't we all tend to gravitate towards what we love to do?? I am not immune!). While I've been in the fitness industry for over 15 years, the last two years have been the most eye-opening even for me as far as my personal results and professional endeavors.

If you've ever done a Mavenaction workout, you'd know what I mean. There are triathletes, runners, and other endurance specialists who could do laps around me till kingdom come, but if I were to have them do...say...10 minutes of burpees, mountain climbers, jumping jacks, squats, they'd be screaming for mercy (which used to be me, by the way)....if I had them attempt a few sets of pull ups and push-ups, they'd be a goner.

I think you get the drift.

In essence, to be the best triathlete you want to be next season, you MUST be fitter. How do you become fitter? Add cross-training (functional resistance training) as PART of your triathlon training, not as something separate; as a soon-to-be certified USAT level 1 coach, this is how I intend on program designing and mapping out your best tri performance next season.

What do I mean by adding in cross-training? Instead of 7 days a week of all cardio or multisport activities during the season, 3-4 days would be dedicated to your sport, and the other 2 days would involve functional, resistance training or a combo of activities; for example, drop and do 20 burpees or 20 push-ups every 100m of running around a track at your 5k pace for 2 laps x 4 sets...try it, I dare you, then come back and visit my blog for more). Of course, remember that you need to make rest a part of your training as well, and for longevity in the sport, 1-2 days/wk is necessary.

We'll get more into the specifics as we move along in this multi-part series.