Brian Schiff’s Blog

According to research, more than 70% of people in the US will experience at least one episode of low back pain (LBP) in their life.  What is known about LBP and jogging?  Keep in mind running is an extension activity in the spine.  It also involves obvious repetitive compression/loading with ground impact.

A recent study in the Journal of Athletic Training (Sept./Oct. 2009) looked at the impact of lumbar paraspinal muscle fatigue and postural adjustments seen in running.  Poor lumbar extension endurance has been linked to increased risk for developing LBP.  In this study, researches looked at 25 recreationally active participants with a history of recurrent episodes of LBP and 25 healthy controls.

The testing process included:

1. 5 minute warm-up on the treadmill
2. 60 seconds of treadmill jogging at self selected pace
3. 1 set of fatiguing isometric lumbar extension exercise
4. Another 60 second treadmill jog at the same speed

For your reference, the fatiguing lumbar exercise consisted of repeated cycles of 10 second, gravity resisted isometric contractions followed by a 10 second rest on a lumber hyper extension chair.  So, what did the results show?

In a nutshell, those with a history of recurrent LBP showed much less postural adjustment with the muscle fatigue compared to their healthy counterparts.  The healthy subjects tended to exhibit a more forward trunk lean (1.1 degrees or less lumbar lordosis) and increase lateral bend during jogging gait.

On the flip side, those with recurrent LBP, they tended to stay more upright (0.2 degrees of additional lean on average).  The authors feel this may indicate a coping mechanism due to core instability and a way to effectively stabilize the spine.    Increased trunk lean would increase forces on the spine and intervertebral disc.  The lack of change in the population with LBP may help explain excessive fatigue in the muscles that support the spine, pelvis and hips.

So what does this mean for those who have LBP?  The postural change, or rather lack thereof, may be an Aha moment in regard to the need for improved core training for runners and athletes.  It should also indicate that long term running or athletic competitions may increase the risk for more frequent LBP or a greater back injury. 

There are three big takeaway messages here:

1. Include low back extension endurance training in your workouts
2. Integrate appropriate core exercises (planks, side planks, 3 dimensional exercise) to improve strength and stability of the hips, pelvis and spine
3. Get professional evaluation and training from a knowledgeable fitness pro if you have LBP

Well, it is just days before I embark on my 3rd half marathon.  Just one short run to go.  And no, I am not suffering from shin splints (lol).  But as I approach the Columbus Half Marathon on 10/18, I am reminded about all the patients and clients I see who are in some way affected by shin splints.

Shin splints, more commonly referred to as medial tibial stress syndrome (MTSS) in medical circles, plague many runners, walkers and athletes.  So, what is a shin splint?  People often report pain and tenderness along the outer or innermost portion of the lower leg.  Anterior shin splints affect the anterior tibialis muscle and are seen more commonly (my experience) in people who walk rapidly for the first time or do several hills without training for them.  I saw a camper of mine who runs regularly develop shin splints doing a 5K walk and trying to walk fast and keep up with another camper.  She never has had shin splints in years of running.

Posterior shin splints are probably more widely seen among most runners.  They tend to be more common in females as well.  The source of pain was commonly linked to the posterior tibialis muscle, but is now thought to be along the origin of the medial soleus muscle and its deep fascial insertion.  Hmmm….. the soleus – now if you have read my earlier posts, that is a muscle I personally know a thing or two about when it comes to injury.

 What are some causes of shin splints?

• Tight hamstrings (affects closed chain biomechanics)
• High or low arches (twice the injury incidence as those with normal arch height)
• Faulty training surfaces (uneven sidewalks and asphalt can be brutal)
• Improper training technique or progression (this is a biggie for sure)
• Muscular imbalances (weak hips anyone?)
• Excessive foot pronation (flattens out or rolls in too much during gait)
• Worn out or improperly fitted/cushioned footwear

What else may cause such pain?  It may be a good idea to see a medical professional for diagnostic testing to rule out a stress fracture (often severe pin point pain along the medial tibia), exercise-induced compartment syndrome, and a possible popliteal artery entrapment (Tolbert and Binkley – NSCA Journal 2009). 

Outdoor boot camps and running are gaining in popularity these days.  Both activities are great for weight loss but also carry a higher risk of shin splints for participants, especially overweight women.  Proper warm-up, selective footwear and stretching are great strategies to reduce or prevent injury.

If you have been affected already and are seeking help, I suggest the following:

1. Relative or absolute rest from the offending activity
2. Ice the affected area daily (2-3x/day)
3. Standing hamstring stretch (flat back) with and without foot rotation in and out – hold for 20-30 seconds in each position (repeat twice)
4. Calf stretching on a step – knee straight – hold for 20-30 seconds (repeat twice)
5. Soleus stretching ona  step (knee slightly bent) – hold for 20-30 seconds (repeat twice)
6. Single leg calf raises to strengthen the posterior tibialis muscle (once able to do pain free) Perform 2-3 sets of 10-15 reps
7. Single leg balance on a slightly bent knee – perform 2 sets of 30 seconds without touching the other leg down (advance to eyes closed for more difficulty)

In the end, combine prevention with sound footwear and a proper training progression and you will have no trouble at all with shin splints.  At the first sign of pain, step back and evaluate if you need to adjust your training as trying to go through it will not make things better.  Happy training all!

In many of my recent posts, I have focused on injuries and recovery.  I am going to start a new series today on improving speed and agility.  You see, even though I consult with hundreds of clients every year on injuries, I also train many athletes for peak performance who are well athletes seeking to maximize performance and stay injury free.

While I will be the first to admit I may not be the most innovavtive coach out there when it comes to unique drills, I do get great results and have very few of my athletes get hurt.  I believe this stems from a sound understanding of biomechanics/kinesiology as well as understanding how force application affects the body.  It is the application of exercise that makes a great coach “great.”

Getting it “just right” takes an exact formula and this is not a universal formula for athletes, even if they play the same sport.  With that said, they are fundamantal issues I see athletes tend to struggle with or need improvement on such as:

• Poor running form
• Inefficient planting and cutting
• Inability to decelerate quickly and efficiently
• Difficulty maintaining a low center of gravity
• Difficulty changing direction quickly

To address these issues, we use certain drills in our speed camps, clinics and athlete performance training.  I thought I would spend the next few blog posts showing you some of the very drills we use to improve performance, reduce or eliminate the weaknesses mentioned above and of course dramatically reduce injury risk.

Repetition is key as we want to fine tune the motor patterns and give the athletes the proper patterns to feed forward in practices and games.  This can only really be accomplished through proper instruction, proper selection of drills and reinforcement of proper form with lots of repetition.

In today’s video, I included a 2 cone figure 8 drill that we used in a 2 hour lacrosse clinic.  It is a realtively simple drill, yet so many athletes struggle to decelerate efficiently, round the cone tightly and then move toward the next cone.  Making large turns reduces speed and often decides who wins on the field.  Learning to stay low and turn properly improves quickness and reduces knee injury risk.

This drill is usually done for 15-30 seconds (2-3 sets) to work on conditioning but allow for enough time to get the repetitions desired.  Start with the cones no more than 10 yards apart and as the skill level and form dictates, move the cones closer to increase the difficulty of the drill.  Be aware that the demand is higher with a shorter distance and you should judge distance based on the athlete’s ability to do the drill properly.

Stay tuned as I will share more videos of drills I use in the coming days and weeks to make you or the athletes you train more effectively.

I recently relased an article on coaching mistakes in our local market.  In it, I talk specifically about 5 critical mistakes coaches make with respect to athletes.  The article will likely ruffle some feathers.  I am not anti coaches in any way (I am one).  However, I do believe coaches need to be educated about how to integrate training to maximize sport performance and reduce injury risk.

Today, I witnessed another example of how good intentions coupled with lack of proper insight about the impact of conditioning can harm an athlete.  We had a new lacrosse athlete in our facility today working with one of my performance coaches.  At the end of the session, my coach asked me to look at the athlete’s knee as the client apparently had anterior knee pain.

The staff member and father informed me that the lacrosse player’s coach was having everyone on the team not participating in a fall sport train for the Columbus half marathon coming up in October.  The aim was simply to accomplish team building (an admirable goal) and keep them fit.  You may know where this is heading.

I performed a movement screen on the athlete and discovered decreased hip strength and reduced ankle mobility.  The player had obvious imbalances on both sides, left greater than right.  The player then mentioned shin splints on the left leg as well for the past week (now 3-4 weeks into the 1/2 marathon training).

So, after performing a thorough knee eval, I concluded the athlete has anterior knee pain and left sided shin splints related to muscle imbalance and overuse with the recent addition of 4 days of distance running.  Is running bad?  In a word, no.  But this type of running for this particular athlete is not helping further performance goals.

The father enrolled the athlete in our program to work on speed, agility and power for lacrosse.  The bottom line is that this 1/2 marathon training is going to work against the very training adaptations my staff is working to achieve, not to mention now causing more knee pain and shin splints.

I am not opposed to the idea of scheduled conditioning for athletes not participating in a sport.  However, coaches need to step back and ask themselves what is the best way to condition their players for optimal performance and injury prevention.  In this scenario, I have all the confidence in the world the coach has the very best intentions for his players. 

Unfortunately, the results may be less than expected here – more importantly they may be counterproductive as the wrong energy system training and adaptations are being emphasized, while some players may suffer injury.

In my professional opinion, the player should probably consider dropping out of the half marathon training for three very important reasons:

1. Resolve pain and shin splints
2. Focus on fixing muscle imbalances
3. Maximize the training with us

This seems so simple, right?  Well, I see situations like this every week in my facility.  I see too many injured athletes.  Why?  In many cases it has to do with faulty conditioning principles or over training.  My mission is to educate coaches about how best to blend injury prevention with performance conditioning relative to their respective sport.  We have to remember that one size never fits all either.

Thoughts, comments or questions?  Let me know.  I am happy to address them in a constructive and positive public forum.

In last week’s post I revealed my core lower body reaches using one leg for stance and the other leg fro dynamic movement.  Today, I will show you 3 fundamental upper body patterns I use with many of my athletes.

They include anterior hand touches, ipsilateral hand touches and contralteral hand touches.  You may progress from a 12″ cone all the way to tape on the floor.  The rotational reaching should only be added after the other two progressions have been mastered.  Perform 1-2 sets repetitions for these exercises.

The purpose of these exercises is:

1. Increase strength
2. Increase stability
3. Improve proprioception
4. Improve mobility
5. Reduce injury risk

I highly recommend incorporating some of these simple yet effective training strategies if you are a field or court athlete or someone who works directly with this population.  In addition, any clients prone to ankle sprains or with a history of knee injuries should be doing some form of these routinely if they are still actively competing.