Brian Schiff’s Blog

So, I have been swamped with work and marathon training, hence the recent delay in a new blog post.  Well, yesterday during a short 3 mile run (I am in taper mode with a 10/17 event) I experienced an acute left hamstring strain.

Hamstring strains are common and can produce incredible pain and limit function.  Most hamstring strains occur as the swing leg is coming forward and the knee is nearing full extension.  Essentially, it is a stretch type injury as the hamstring works to decelerate the momentum of the lower leg.

Injuries may be casued by inadequate warm-up, a sudden increase i training intensity/volume, fatigue, stiffness, weakness or muscle imbalances.  A prior injury may also increase your risk for re-injury.

I have been running for years and am 5 months into my marathon training, so why now?  I honestly think it may be related to my speed yesterday.  My body naturally leans toward a 7:25 pace, but when I looked down at my Garmin yesterday at the point of pain, it said 6:54.  Yikes!  I was 1.25 miles into the short run.

I decided to keep running and slow my pace back to 7:30.  While I was able to complete the run, my lower hamstring was very tight and sore after the run.  Obviously, I have been icing regularly the last 24 hours.  No running today either.  I anticipate a quick recovery since the strain is mild and I am very fit.  But, what is the best way to prevent re-injury?

I have a quick article summary from the Journal of Sports & Orthopedic Physical therapy Journal for you to read that underscores how important functional movement rehab is in comparison to just static stretching and strengthening.

Click here to read the summary of the journal article

Now, with respect to running, agility may not be necessary.  Running is fairly linear (straight line) so what may be more important to gage capacity to return to running may be some of the following:

• Absence of pain with active knee straightening
• Absence of pain with walking
• No pain with single leg hopping
• Minimal to no muscle belly tenderness

In the end, you will need to let pain guide you.  Some will return faster than others, but inside of 21 days (the end of the subacute healing phase) you must be aware of the fragility of the tissue as it heals.  I am confident this will not derail my marathon, but the lesson learned is to watch your starting pace as it may lead to some muscle strain.

It is no secret that Americans are trying to stay more active well into their baby boomer years and beyond.  The million dollar question is how will what you do today affect your joints down the road. 

Scholars, scientists and medical experts do not seem to agree 100% on what is too much, but most tend to agree that excessive running, obesity, irregular or unusually intense activity (think weekend warriors here), muscular weakness and even decreased flexibility may all contribute to arthritis.

The New York Times recently ran a story about the cost of total joint replacement and suggestions on how people can be proactive to reduce the risk and debilitating effects of arthritis.  Click here to read the article.

I think one of the most amusing yet ironic things about science is that it often contradicts itself.  Obviously, we know being overweight increases stress on the load bearing joints.  Most people would also knowingly acknowledge that improved strength and flexibility would make for healthier knees and hips. 

The big question mark for me is impact loading, or simply the argument of whether to run or not to run.  Some docs say no way.  Others say yes.  Yet others offer more ambiguous words on the subject.  So, what do I think?

I honestly believe there may be no absolute answer.  I am not convinced running on a treadmill is all that much better for you as some would suggest either.  My body tells me blacktop surfaces are better than cement sidewalks, while the soft earth is better yet still.  I use the treadmill in the winter and for speed work but if you run events too much treadmill work will let you down on race day as the body is ill prepared. 

Much like exercise prescription, I think joint loading and tolerance is a very individual matter indeed.  Biomechanics, posture, training history, medical history, repetitive movements, footwear, nutrition, body type, recovery, etc are just a few of the variables one must consider when passing judgment on exercise prescription and limits.

Beyond that, the best indication to reduce or remove an activity for a short bit or long term is obviously pain.  But before doing so, one must correctly identify the source of the pain.  At times, the pain may seem like a joint issue when in fact it could simply stem from poor muscle recruitment, lack of mobility or faulty movement patterns thereby subjecting joints to undue stress.

I say all this to say we must be careful in saying one should not do something definitively.  Some folks run well into their 80’s without issues.  Others break down after one endurance event.  In the end, we must face facts.  The human body is complex and no two people are exactly alike.  I had left hip pain years ago that felt like arthritis.  My orthopd told me the x-ray showed a few mild bone spurs and mild hip dysplasia. 

His advice?  Quit running.  I did for 6 months and the pain did not subside.  So, I began a progressive running program and changed up my strength training to more single leg based work.  Guess what?  My pain went away 100%.  This tells me the impact itself was not likely the cause of my pain, but more likely a muscle imbalance that I overcame through more efficient strength training.

We must look at science, anecdotal findings and clinical experience to pull out general patterns and thoughts all the while continuing to use assessment, feedback and results to lead us to the best conclusion for each client, patient or athlete.  You must use all this information to make the best decision for your situation as well.

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!

So, if you know me well at all, you know my first “law of exercise” is to ALWAYS know why you do what you do.  I read a newsletter by Mike Boyle yesterday.  He talked about being a cook or chef when it comes to exercise.  He advises those with less than 5 years of expereicne not to mess with the recipe much so to speak.  Since I have been doing this for 12 years, I consider myself to be much more of a chef.

I am constantly creating and tweaking my programming to deliver the best results.  So, when I decide to use a training aid or piece of equipment, I have to believe in it 100%.  My athletes and adult clinets alike love bands, vests, balls and training toys if you will.

But, I have to remind them (and myself at times) that the training aid exists only to further advance the original exercise or its desired outcome.  Using these things just for variety is not really a sound plan.  Today, I have a short video for you that reveals four progressive ways to use the Thera-band stability trainer.

I have used this in the rehab setting and in my fitness programs with great success.  Please note – all of the exercises I show you should be mastered on flat ground first.  After that, the stability trainer adds a great new dimension to the exercises and provides a very natural disturbance to balance and stability throuhg the kinetic chain that exists in sport and life.

Now, these are a just a small sampling of some of my favorite Thera-band trainer drills.  The cool thing about this item is that it comes in three different levels of difficulty moving from green (easiest) to black (hardest).  I tend to prefer the blue as it is middle of the road, making it easy enough for those without the skill of an Olympian and yet challenging enough for even the more advanced athletes.  However, starting with the green may be necessary for those with ankle/knee instability or limited experience with stability training.

You can grab your very own blue Thera-Band trainer in my OpenSky Shop.  Click the image below to head on over and get free shipping for a limited time as well.