Brian Schiff’s Blog

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.

Well, Thanksgiving is upon us in 2011. I want to wish you and your family a wonderful holiday. In today’s post I will review a November 2011 article in the American Journal of Sports Medicine that looked at the effect of the Nordic hamstring exercise on hamstring injuries in male soccer players.

For those not familiar with Nordic hamstring exercises, see the photo below:

In this randomized trial, the researchers had 54 teams from the top 5 Danish soccer divisions participate.  They ended up with 461 players in the intervention group (Nordic ex) and 481 players in the control group.  The 10 week intervention program was implemented in the mid-season break between December and and March because this was “the only time of the year in which unaccustomed exercise does not conflict with the competitive season.

The trial was conducted between January 7, 2008 and December 12, 2008 with follow-up of the last injury until January 14, 2009.  In the intervention group, all teams followed their normal training routine but also performed 27 sessions of the Nordic hamstring exercises in a 10 week program (as follows)

• Week 1 – 2 x 5
• Week 2 – 2 x 6
• Week 3 – 3 x 6-8
• Week 4 – 3 x 8-10
• Weeks 5-10 – 3 sets, 12-10-8 reps
• Weeks 10 plus – 3 sets 12-10-8 reps

The athletes were asked to use their arms to buffer the fall, let the chest touch the ground and immediately get back to the starting position by pushing with their hands to minimize the concentric phase.  The exercise was conducted during training sessions and supervised by the coach.  The teams were allowed to choose when in training it was done, but they were advised not to do it prior to a proper warm-up program.

And the results…..

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I work with many runners in our clinic.  I often see restrictions in the soleus.  While the running community is warming up to soft tissue mobilization, many runners are still resistant to embrace it routinely and engage in it more so only when they are hurt or lacking flexibility.

STM (soft tissue mobilization) should be part of every runner’s maintenance program.  Why?  Simply put, repetitive stress takes its toll on the body.  Rolling or releasing the tissue increases blood flow, eliminates trigger points, and facilitates optimal soft tissue mobility and range of motion.

In the diagram below, you can see common trigger points in the soleus.  The X represents the trigger point & the red shaded area is the referred pain caused by the trigger point.

In the case of the soleus, restricted dorsiflexion could lead to other biomechanical compensations with running.  Initially, this often creates a dysfunctional and non-painful (DN) pattern.  Over time, this may eventually become a dysfunctional and painful (DP) pattern forcing runners to seek medical care.  The terms DN and DP come from Gray Cook’s Selective Functional Movement Assessment (SFMA).

The gait cycle is certainly altered from dysfunction in this muscle.  If ankle joint dorsiflexion is compromised (a common effect of soleus restrictions), there can be increased strain on the quads and altered movement in the hip.  Overpronation and excessive hip adduction and internal rotation are common compensations seen with running.  Other signs and pathology that may be associated with a soleus trigger point may include:

• Plantar fasciitis
• Heel pain
• Shin pain
• Knee or hip pain
• Back pain

As such, restoring mobility is important.  A recent study revealed that immediate improvement in ankle motion can be attained with just a single treatment (click here for the abstract).

So how do you effectively resolve soft tissue issues in this area?  I suggest using a foam roller or better yet the footballer and baller block in the Ultimate 6 Kit for Runners by Trigger Point (see pic below)

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Today I am going to share two pieces I have written for other publications as I think the exercises I discuss have real merit and broad application for competitive athletes and weekend warriors.  I am a columnist for PFP Magazine and Endurance Magazine and these articles come from those publications.

Single Leg Theraband Activation Squats

The idea behind this exercise is applying progressive gradients of resistance that encourage the faulty motion (pulling the leg into adduction and internal rotation) to facilitate increased activation of the gluteus medius/minimus and small lateral rotators to create an anti-adduction/internal rotation force.  Decreasing such moments at the knee will reduce IT Band issues, patellofemoral pain, ACL injury risk and overuse problems often seen in running.

Click here to see how to perform the exercise

Mobility Training for Endurance Athletes

It is no secret that endurance events require repetitive motion and often carry a higher risk of overuse injuries.   In light of this, poor thoracic extension and/or limited ankle dorsiflexion negatively impact proper running and riding mechanics and lead to faulty movement patterns.  Beyond physical stress, this reduces performance capacity as well.  There are two simple mobility exercises to help correct imbalances that may be hindering you.

Click here (go to page 16) to see how to sustain your body with these exercises