Brian Schiff’s Blog

This exercise is an excellent way to increase hip disassociation and more specifically hamstring flexibility.  Foam rolling and/or myofascial compression therapy prior to stretching may further enhance range of motion.  This exercise can be used with runners and clients struggling with tendonitis, IT band issues and patellofemoral pain.  It is also helpful in eliminating asymmetry that appears on the active straight leg raise on the FMS.

This exercise can be used as part of a mobility workout, warm-up, regeneration day or at the end of a workout. Remember that maximally dorsiflexing the foot will increase dural tension and place more stretch across the back of the knee.  So, relaxing the foot (or placing the rope more along the mid foot) will reduce this tension and allow for a more concentrated stretch in the hamstring.  For clients with a history of sciatica, I would suggest avoiding the stretch with the foot in full dorsiflexion as a general precaution.

It has been a while since my last post.  To be honest, I have been busy with preparing/presenting my live seminar last week and webinars, as well as fulfilling my writing obligations and clinical role.  So, I have been taking a “break” from blogging and recharging the battery so to speak.

Now I am getting back to it.  The great thing about presenting though is that I am consistently reading and reviewing the latest research on topics related to my presentations and closely examine my rehab and exercise philosophy.  In my clinic, I treat many runners for knee pain.

The average profile is an experienced runner b/w the ages of 25 and 50 who logs 20 – 35 miles per week and routinely competes in half marathons or some sort of triathlons.

Common injuries include IT band problems versus lateral meniscus tears versus patellofemoral pain.  Often, I uncover the following things related to kinetic chain deficiencies:

• Elevated or rotated inominate
• Ankle dorsiflexion restriction (OH squat assessment)
• Poor single leg stance
• Weak lateral myofascial chain
• TFL dominance
• Excessive femoral internal rotation/adduction with single leg squats
• Tightness in hip flexors, ITB and soleus

Many currently debate the efficacy of foam rolling.  Is it worthwhile?  Some say yes, while others say no.

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There seems to be consistent questions, debate and studies done with respect to stretching.  As the thought of more closely analyzing the quality of movement (FMS, Y-Balance testing, SFMA for example) moves to the forefront in the PT and fitness world, many search for the right mix of exercise to maximize mobility.

I count myself as a supporter and follower of the work of Gray Cook and Stuart McGill.  While I may not agree 100% with all of their ideas, I generally consider them to be brilliant minds and ahead of the curve.  I have been using the FMS in my practice for some time now and have also begun to incorporate Y-Balance testing as well (see pic below courtesy of the IJSPT)

The Y-Balance test may not have significant relevance to hip mobility as much as it does limb symmetry, but I included it here to illustrate my point in observing kinetic chain movement to help determine where the weak link or faulty movement pattern may be.  It gives us valuable information with respect to strength, balance and mobility.

With the revelation that FAI is more prevalent than we knew (click here for my post on FAI), I am always interested in hip mobility and how to increase movement in the hip joint.  Limitations in hip mobility can spell serious trouble for the lumbosacral region as well as the knee.

I currently use foam rolling, manual techniques, dynamic warm-up maneuvers, bodyweight single leg and hip/core disassociation exercises and static stretching to increase hip mobility.  However, I am often faced with the question of what works best?  Is less more?  How can I make the greatest change without adding extra work and unnecessary steps?

Well, Stuart McGill and Janice Moreside just published a study in the May 2012 Journal of Strength & Conditioning Research that sought to examine three different interventions and how they improve hip joint range of motion.  Previous work has been focused on the hip joint alone, and they wanted to see how other interventions impacted the mobility of the hip.  Click here for the abstract

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Well, after a silent stretch the past 2 weeks or so related to my study/preparation for the OCS exam, I am back to blogging! Today’s post is a pertinent one for runners and athletes suffering from lower limb injuries.

Static stretching has taken a bit of a beating in the strength and conditioning world in the last few years. Dynamic warm-ups and active mobility have taken center stage as of late.  While these active modalities are certainly superior for prior to practice, play and ballistic activity periods, I still believe stretching has a place in rehab and conditioning.

Interestingly enough, a study recently published in the March 2012 Journal of Strength & Conditioning Research examined the effects of static stretching of the calf and its impact on the strength/ROM of the contralateral side.  Click here for the abstract.

In a nutshell, the authors had two groups of untrained individuals: test group (6 male and 7 female subjects) and control group (6 male and 6 female subjects) who participated.  The test group did supervised active right calf stretching 3 days per week for 10 weeks (four 30 sec stretches w/30 sec of rest between stretches).  They stood on a beam 30 cm above the floor with the left knee slightly bent to offload the left leg as well as placing the hands on the wall while they leaned forward allowing the right heel to drop toward the floor until a max tolerable stretch was felt.  The knee was straight throughout on the stretch side.

Control subjects did no stretching at all.  All subjects were instructed to maintain their normal physical activity but refrain from any resistance training or stretching during the 10 week investigation.  The results:

• 29% increase in 1RM calf raise strength on the right
• 11% increase in 1RM calf raise strength on the left
• significant 8% increase in calf ROM on right
• significant 1% decrease in calf ROM on the left (non stretch side)
• No change in strength or ROM for control group

The authors conclude that the results of this study best apply to rehab settings.  For example, they suggest that this procedure may be an effective way to combat the loss of strength in limbs that have been immobilized after injury or surgery simply by stretching the mobile (unaffected) side.  They also point out that this may be a way to mitigate strength loss when access to traditional strengthening modalities are not readily available.

Clearly, athletes suffering an acute ankle sprain as well as runners suffering soleus/Achilles/lower limb overuse injuries would benefit from such a strategy. So why does this work?  Zhou in earlier work describes a cross training effect due to neural adaptations regulated in the spinal cord.

What does this mean for you and me?  Well, as someone who works with many runners I am always looking at eccentric control of the G/S complex as well as effective single leg heel raise strength.  The idea that stretching the uninvolved side to strengthen the involved side seems like a no brainer.  Clients suffering from tendonitis, plantar fasciitis, stress reactions, sprains and other injuries can use this as an early intervention without stressing the involved side.

More importantly, I like the idea of increasing neural adaptation and ROM in the stretch side through eccentric load as the dissipation of ground reaction forces will be more efficient in a calf that effectively handles eccentric loads through a sufficient range of motion.  This study definitely highlights the importance of stretching in novice runners and those with tight gastrocs. I am curious if the bent knee stretch would have had a similar effect primarily on ROM – perhaps they will investigate that further in the future.

As we move more toward mid and forefoot running gait, I believe the fitness of the G/S complex will be even more important than before as stress is transferred away from the knee and more toward the foot/ankle complex.  Clearly, we need more studies in trained subjects on unilateral stretching to determine if the same effects and degree of impact will be seen, but this study shows some promise for active static calf stretching in the appropriate populations.