Brian Schiff’s Blog

It is clear that our society loves shoes and fashion.  The problem is that fashion often does not equate to good function.  Keep in mind your feet set the tone for the rest of your body’s biomechanics so it stands to reason that one would want to pay close attention to their foot structure and use the RIGHT shoes more often than not.

I treat and evaluate lots of runners on a weekly basis.  I use the FMS, selective testing and gait analysis to help them resolve mechanical issues, overuse problems and improve running efficiency.  However, when it comes to making footwear choices, I can only counsel them on what is best.

Recently, I wrote a column for Endurance Magazine on the impact of high heels and flip flops as it relates to injury risk.  At the end of the piece, I give some exercises to address shortened muscles and soft tissue.  I think all women who enjoy running (symptomatic or not) should give this a read.  Click here to read the article.

I thought a fitting way to kick off the new year would be to share the top 10 things I learned or embraced that have most shpaed and impacted my training and rehab this past year.  In no particular order I will rattle these things off.  I hope at least one of these little pearls has a positive impact on your training and/or rehab as well.

1. Often times it appears necessary to perform a biceps tenodesis or tenotomy in active adults undergoing a SLAP repair to ensure more predictable pain relief.  I heard this at a sports medicine conference last May and I can tell you those patients having this done alongside their shoulder surgeries seem to recover quicker with less pain relief.  With that said, keep in mind that SLAP tears are difficult to define and operate on as surgeons still do not have great agreement across the board on defining the extent of injuries and how to deal with them (operative vs. non-operative).
2. Performance on the Functional Movement Screen (FMS) has little to no correlation with athletic performance.  I screened an NBA player and an NFL player this year who both failed the screen.  However, they obviously have mad athleticism and genetic ability.  Keep in mind the FMS is a valuable tool used to assess movement and expose injury risk patterns based on the 7 tests.
3. Soft tissue therapy is undervalued and misunderstood by most lay people.  Assessing tissue restrictions and educating our clients to perform self myofascial release techniques is essential if they want to compete and remain healthy day in and day out.  Specific problem areas I have increased my focus on this year have been the psoas, soleus and posterior rotator cuff/joint capsule.  Click here for my soleus blog post.
4. Core training is probably as much about not moving as it is about generating force with movement.  I read work from Stuart McGill and other smart people in the field, and the concepts of anti-rotation and anti-extension are sound concepts to explore and look more closely at.  Many times, performance in sport and life require us to resist movement and maintain position so strengthening the core to resist potentially harmful and stressful motions is and should be an important part of training and rehab programs.  Understanding how to facilitate and activate core musculature in the training to protect the spine and improve mobility/strength is key.  Click here for more on my core training.
5. Hip dissociation is an important element to train as the lack of it can impact function and performance in a negative way.  We assess it on the active SLR in FMS and I see the lack of it show up on clinical exams all the time.  Whether it is HS tightness, hip flexor weakness or simply poor neuromuscular control, clients who are unable to effectively dissociate the hips are more prone to injury and limited performance.
   Continue reading…

One of the most common PT clients I see is an injured runner.  There can be a umber of different reasons or factors involved leading up to a running injury, but I wanted to focus on this idea of gait retraining that is taking place today.  With the advent of Born to Run and minimalist footwear, people have begun to question and debate what the best way to run is.

Is this suited for everyone?

Let me just say right away that I do not believe there is a simple answer here.  Human beings are all unique and have different genetic and biomechanical makeups.  What this means in effect is that they have their own set of “issues” if you will that I classify into common categories such as:

• Static alignment problems (arch, knee, hip, etc)
• Static and dynamic balance deficits
• Inefficient gait mechanics
• Muscle imbalances
• Soft tissue tightness
• Recurring pain patterns

The list could go on and on, but you get the point.  The idea of “re-teaching” someone how to run differently than their natural motor pattern dictates in not easy and is a decision that should be well thought out and based on sound decision making.  We are pre-programmed at birth with certain native motor patterns and running is one of those patterns.  Generally, your brain finds the most efficient way for you to run in your own body.

Now granted, some run much better than others.  Perhaps we can say athleticism plays a role in this, but as we grow and reach skeletal maturity our body type, training experience, strength and environment are also major factors .  With that said, I know that runners with recurrent and/or chronic pain are looking for a finite solution to their problem.  They grow frustrated when they are unable to log all their miles or finish a race.

If traditional PT or relative rest fails to alleviate the pain, we must delve deeper and look more closely at their gait.  I think video analysis is a great tool for doing this.  We use Dartfish at my clinic, and this is very useful for breaking down gait mechanics and detecting things like heel versus forefoot striking, overpronation, asymmetry side-to-side, trunk inclination, etc.  Once we find things on video we must also correlate these findings to our clinical screening to uncover a cause and effect relationship.

Continue reading…

Wow!  It has been a busy two weeks for me.  I have been putting the final touches on a DVD and writing a ton of articles lately.  I just returned from speaking for Power Systems at a Total Training Seminar in Missouri in late March.  It is always interesting speaking and hearing other presenters.

There is usually no shortage of controversy and conflicting opinions either when it comes to fitness and training.  One speaker mentioned that it is perfectly okay to allow the knee to go over the toe with exercise.  In fact, this presenter said it was desirable to maximize training.   My talk (later on) was on bodyweight training for a healthier knee.

Naturally, I was asked what I thought about the earlier comment.  My answer was “it is complicated.”  I am not sure that is what the audience wanted me to say.  Pressed again later on, I acknowledged that in a repetitve training environment, lunging and squatting with the knee over the toe is not something I recommend.  However, if I am retraining a client to be able to descend stairs one foot over the other, the knee does in fact move beyond the toes.

So, there are times in life, where we need to think outside absolutes and adjust our thoughts and training to meet the needs of people at a current time and space so to speak.  The real trick is knowing the client, their medical condition, their needs and measuring the response from the body.  I hate protocols because no two people are the same, nor do their bodies heal and react the same way.

But, let’s get back to the knee.  I talked about assessing the knee and then integrating the “right exercises” to not only correct dysfunction but also to improve fitness and performance.  If you think body weight training is useless or for sissies, you may want to think again particularly if you like to run and have any issues with patellofemoral pain (most women do have PF pain or early arthritis).

Consider the research from the Journal of Orthopaedic and Sports Physical Therapy in 2003 where Powers et al. determined that PF joint forces are significantly  greater with external loading versus bodyweight only in flexion angles begining at 45 degrees during eccentric loading (lowering down while peaking at 90 degrees) and concentric loading (rising up) at 90 and 75 degrees.   What does this mean for you?

Essentially, if you are a runner and suffer from PF pain, you may want to limit deeper range of motion with squatting and/or consider limiting the amount of external loading as well.  Even better, you should be doing single leg training keeping this same information in mind.  Training is an exact science and most people get it wrong all the time.  That is why I am currently working on a Fit Knees DVD series to give trainers and consumers relevant and science based information to direct their training for optimal health and performance.

I just finished volume three in this series and it is ready for official release this Friday.  If you are a runner and want a blueprint to train for injury prevention and peak performance, this DVD is for you.  Or, if you are a runner who is currently injured or has been plagued by overuse injuries, it is still for you as I have a complete progressive rehab series on the DVD to get you back up and running again. 

As a runner myself, I have put these strategies to good use with much success.  I thought it was fitting to relase the DVD this week as I prepare to run my 4th half marathon in Charlotte this weekend.  Below you will see the product display. 

As a blog subscriber or reader, I am offering you $10 off the normal price of $34.95 through midnight Saturday.  Simply visit www.fitknees.com and use the copuon code BFITRUN (all caps) at checkout.  I am confident you will find it valuable as it covers training from A-Z with warm-up prep, foam rolling, balance training, strength and power exercises, rehab and stretching.  It is 65 minutes of power packed content.  Here’s to healthier knees and happy running!

It is fairly well accepted in medical/rehab circles that much of the lateral knee pain felt by runners is related to the IT band.  Researchers report that frictional forces are greatest between 20 and 30 degrees of knee flexion (this occurs in the first part of stance phase with running).   But what about the differences in hip and knee kinematics between healthy and injured subjects?

I currently train two competitive female marathoners.  Both are in their thirties.  One has run Boston and the other is training with me to qualify this year (she missed by 36 seconds last year).  Many female runners deal with iliotibial band issues during their training.  My client trying to qualify for Boston has issues on her right side.  My other runner does not.  The client affected by this also has some ankle instability which certainly affects closed chain mechanics.

Historically, researchers have felt increased rear-foot eversion has contributed to such injuries.  Why?  well, increased rear-foot eversion leads to increased tibial internal rotation, and by the ITB’s attachment point distally on the tibia this would in turn increase strain.  In addition, it has been postulated that gluteus medius weakness leads to greater hip adduction moments and undue strain.

One recent prospective study done by Noehren et al. concluded that runners who developed ITBS exhibited increased hip adduction and knee internal rotation angles compared to healthy controls.  Today, I wanted to briefly update you on a study just published in the Journal of Orthopaedic and Sports Physical Therapy looking at the running mechanics of those with previous bouts of ITBS and those without.  The study observed 35 healthy female runners and 35 age matched runners (ages 18-45 who run no less than 30K/week) with a history of ITB issues.  They measured:

1. Hip, knee and ankle kinematics
2. Internal moments during stance phase

So, what did the results say?  In a nutshell, the ITBS group did in fact exhibit increased hip adduction angles and peak internal rotation angles at the knee.  There was , however, no significant difference among groups with respect to the rear-foot eversion.  This particular study did not measure hip abductor strength.

As far as limitations to the study, one primary one was the fact that the ITBS group was healthy during the study (meaning they had some time in the past suffered ITBS).  With that said, the results did mirror the prospective study by Noehren.

The practical takeaways for runners and trainers are:

• Prior ITB issues may increase risk for recurrence due to increased strain
• Prior ITB issues indicate atypical hip and knee kinematics may be present
• The rear-foot position may have a lesser role in causation of ITBS
• Addressing hip stability, strength and eccentric control is paramount to injury prevention
• Observing frontal/transverse plane knee mechanics is prudent

In training, I recommmend video analysis or using a mirror independently to observe what I term a single leg hop and stick maneuver.  I teach it to all my cutting and impact athletes.  Simply begin on the left leg and hop forward onto the right and lower down into a lunge type single leg landing position.

Observe the foot/ankle, knee and hip as the body declerates.  This image and sequence of events leaves strong clues about the strength and force dissipation that is or isn’t happening.  Perform at least 3 trials and repeat on the other side.  This evalaution technique then also becomes a training tool to correct imbalances and improve deceleration mechanics – the very essence of the injury problem to begin with.

I routinely have my athletes with assymetrical or atypical kinematics engage in this drill no less than 2-3 times per week.  I have them perform 2-3 sets of 5-10 quality reps on each side (alternate sides).  Focus on preventing the femur from adducting too much or the patella moving inward.  In addition to this drill, obviously include steady glute max and medius work in your programs to help reduce ITBS.  With all that said, happy running!