My Top 5 Posts of 2014

Howdy Readers! It is that time of year again when everybody begins to look back and review the past year. 2014 was definitely a big year for myself professionally and personally. In fact, 2014 was my first full year of blogging since beginning to write back in early 2013. Some highlights of my past year include finishing my master's thesis and degree, going to the final four (NCAA Div. III) with my basketball team from Illinois Wesleyan University. Additionally, I moved between Normal, IL to Madison, WI and finally settled here in Miami, FL where I have started work on my PhD at the University of Miami. This means I have gone from being a student and clinician to full time student/research assistant. Finally, in my personal life I was lucky enough to somehow become engaged to the woman that I love.

Now that I have reviewed my personal and professional life...let's take a look and recap the 5 most popular blogs that were published on my blog this year. I only included posts that were written & published in the past year for eligibility. Cue the cheesy drum roll please!

5. Healthy Running Course Review

This post was a recap of my trip to Portland, Oregon where I attended the Healthy Running Course that was put on by Dr. Mark Cucuzzella and Jay Dicharry, MPT, SCS. I had a great time at this course and in my mind the information presented here is a MUST for people interested in running, coaching runners, or treating running injuries.

4. Please Leave Your Poor Hamstrings Alone!

This post was kind of a personal rant about what has been deemed "The Epidemic That Never Existed". If you haven't read it yet and think you might have tight hamstrings or find yourself thinking that many people might have tight hamstrings then you might want to check this post out! The sensation of a tight muscle is often no more than that...a sensation.

3. Tibial Internal Rotation Mobilization w/ The EDGE Mobility Band

This post presented a way to help increase tibial internal rotation mobility using the EDGE mobility band. I've said it once and I'll say it again that the band is not necessary and this technique can be done without it. While I have no research to back this (idea!) it does seem plausible that using the band can help with hand grip, increasing afferent input to the nervous system, and perhaps offer a superficial fascial glide at best. These three things together may help increase the efficacy of the technique.

2. Rocktape: Fascial Movement Taping Levels 1 & 2 Course Review

This post is the second course review to hit the top 5 list for the year. In this post I reviewed my time spent at Rocktape's Fascial Movement Taping course. While I haven't used any kinesiology tape in many months now because most of my time is spent in the classroom and in the lab. However, I still believe that kinesiology tape still has a role as a tool in the clinical toolbox. I hardly believe there are any true mechanical effects going on with its application and instead think it is mostly related to sensory input and/or the individual's perception(placebo potential!) of the taped area. (This could be argued because you need the mechanical stimulation to provide sensory-afferent input) I think the evil side of kinesiology tape is often the explanatory and specificity models offered by many and the fact that the research isn't strong for it at all. I do however think that there needs to be better research studies with better "questions" asked as well.

1. Are Your Shoulders Ready for Brazilian Jiu Jitsu?

Finally, the #1 post of the year. The fact that this post became my #1 viewed post of the year was very surprising to me. I wrote this post in honor of starting back up my Brazilian Jiu Jitsu (BJJ) training that had been on hold since sometime during my undergraduate degree. In this blog I proposed a simple but not necessarily all inclusive way of trying to screen a person's shoulders for the mobility needed to withstand the rigors of training BJJ. 

Specifically, I discussed how the Apley's Scratch test positions or the SFMA Shoulder Movement Patterns did a very good job of examining the motions needed for BJJ and explained how these movement patterns matched those of very common submission attempt positions. An inability to properly place your shoulders in these positions active or passively is probably a red flag considering that others will be trying to force your shoulders into these positions and beyond. This could result in increased levels of stress and strain placed on your joint and its surrounding soft tissues. An ounce of prevention is worth a pound of cure.

There you have it, my top 5 posts of 2014. Later this week I will share with you all the top 5 viewed videos of 2014! I hope you all are enjoying the holiday season and I wish you all the best in the coming new year! Thank you all for reading my rambling!

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Three Non-Negotiables for Running

Running a half-marathon indoors is as boring as it sounds.

Howdy Folks! Howdy? Why do I say that? I don't know but here in Miami everything keeps on thinking that I am saying "How ya doing", so perhaps I need to find a new greeting. Nevertheless, lets get back on track. Speaking of track...Do you run, work with runners, or want to run? I wrote today's post to share with you all some concepts that I learned from Jay Dicharry and Mark Cucuzzella at the Healthy Running seminar.

So guess what...? There is a lot more to running that going in circles around a track or bombing down trails in the woods. How about we break it down and discuss three critical components to running?These are critical for running "better" without taking a hit to your economy or risk of injury. I didn't say these three concepts will make you the best runner or prevent 100% of injuries. However, if you don't have these three things then you my friend are missing a few pieces of the puzzle.

1. Runners Need Mobility. Not More but Not Less.

What the heck does that mean? It means you need just enough mobility to move what needs to be moved without creating a compensatory movement pattern. It also means that going above and beyond that threshold may not be beneficial. We are talking Goldilocks here, not too tight and not too loose. We need you to be just right. The good thing here is that "just-right" probably fluctuates between body type, activity type (sprinter vs. distance vs. hurdlers), and running form. However, there are some minimums. We need enough mobility to allow our legs to extend behind us. This requires adequate hip extension, ankle dorsiflexion, and first ray dorsiflexion. We need other joints to be mobile as well but these are the essentials. How much? We are looking for 15-20 degrees of hip extension, 30 degrees of ankle dorsiflexion and another (ankle is already dorsiflexed to 30 degrees before measuring great toe mobility) 30 degrees of metatarsophalangeal (MTP) dorsiflexion of the first ray on top of that. These are not "normal" ranges of motion for these joints but these are the amount needed for running.

2. Runners Need Stability.

If you try to drive a car with poor alignment very far then you are in for a hard a time. The human body is no different. You need a stable and properly aligned "chassis" for efficient energy transfer. This means you need enough "core" control or stability to maintain your alignment while running, for the entire run. You need to be stable from stride 1 through mile x/the finish. This requires stability in all three planes and not just the sagittal plane where many of us tend to hangout. I see poor stability as a common fault for many of us. It is challenging to have proper motor control, especially for long periods of time. We do not want unstable levers to interact with and try to control high/rapid forces.

You need to be stable from beginning to end.

3. Runners Need Strength & Power.

You're a runner, right? The prime example of an "endurance" athlete. Pure cardio, pure aerobic metabolism, purely about getting in the miles or minutes. Wrong. Runners need proper levels of strength and power as well. There is plenty of evidence to show that weight training can be very beneficial to endurance athletes and runners! Your hips (glutes) need to be able to propel your entire body up and forward...very very quickly, many many times. In addition, vertical ground reaction forces (vGRF) in running peak at about 2.5x body weight! Think about that for a second...That would be the equivalent of a 150lb runner doing a single leg back squat with 225lbs on the bar for a total of 375lbs through one leg!

What about plyometrics? Economic running is very plyometric in nature...it is all about how well you can store and release elastic energy! If we are going to have stable levers from non-negotiable #2 then lets take advantage of that and apply some large forces through them!

Gravity is relentless. You need to be strong because we are always fighting it.

In Conclusion

Take these three concepts in isolation and they make sense. Look at them in combination and they make even more sense! Hey wait a minute! How do these things even help runners? Well, overall these are needed to better our running economy and that is done by addressing two key concepts of economic running form.

• Better Storage and Release of Elastic Energy
• Minimized Loading Rates

Now we just need to take these conceptual ideas and put them into practice, right? Stay tuned for future posts where we will discuss how to evaluate and address these issues.

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Healthy Running Course Review

Hold on a second guys....Okay, there. Sorry. I had to come down from what I imagine being on cloud 9 feels like. I have had one crazy, jam-packed, and exciting month so far. The month concluded with two pretty big events. First of all, I finally got around to popping the question...and thankfully she said yes.

On top of that I had the opportunity to travel to Portland, Oregon to attend one of the newly established Healthy Running Courses. In addition to being a course participant I was invited to present the findings of my research on Correct Toes and Lems during one of the lunch breaks! So I wanted to write up a post with my thoughts and feelings regarding this new continuing education course that is geared toward medical professionals, running coaches, and fitness professionals that deal with endurance athletes. There was even a few purely recreational runners in attendance as well!

I was pretty nervous in this photo but not as nervous as I was for the next one...

This was a pretty nerve wracking moment.

Additionally, in about a week I will begin a road trip with my new fiance in order to move to Miami. There we will reside for the next 4 years or so while I begin work on my PhD from the University of Miami. A lot of culture and geography shock in my life lately...

Pretty Sweet geography around Portland. I am very jealous of everyone that lives here.

So where do I actually begin with this course review? Initially, before the course actually began I had wanted to create a large, and detailed write-up about this course. I wanted to share a lot of the information that was discussed, reviewed and learned throughout the weekend. However, at the time I didn't realize just how vast, over-reaching, and yet enjoyably specific the content would be. I could actually write or should I say it would require me to write MANY blog posts to cover everything. Instead, I figured that I would share with you all my general thoughts and feelings.

I arrived on Friday afternoon in Portland and was given a tour of the Correct Toes' office and the clinic (Northwest Foot and Ankle) of Correct Toe's creator, Dr. Ray McClanahan, DPM. Northwest Foot and Ankle/Correct Toes was the host for this conference and boy were they ever a hospitable group of people.

This group went above and beyond and I think this added to the overall open and friendly feeling that existed at this course. This wasn't one of those CEU courses where people sit next to each other and only talk the bare minimum, ignore each other in the halls, and bust ass to leave at the end of the day. I felt like this course, it's instructors, and the participants all fostered a very open, inviting, and collaborative format. On Friday evening, there was a dinner and drinks at a local restaurant to work as an ice breaker before the next morning's festivities.

A family physician, massage therapist, podiatrist, athletic trainer, chiropractic student, certified athletic trainer, and a physician from Canada all at one table the night before the conference. Talk about collaboration...Talk about stories...Talk about Passion.

The next morning I woke up early before the conference to enjoy some local coffee while watching the last couple stages of Le Tour de France. Talk about the type of weather that makes you fall in love with a place.

Portland at 6:30AM...Peaceful at worse.

I was probably the first course participant to arrive on Friday morning but the food and beverages that were catered for breakfast beat me (lunches were also provided and catered, the second day we had Chipotle for lunch!).

Upon arrival to my seat I found some sweet swag in my goodie bag...I was very delighted when I began to rifle through the contents. Actually, I am sure everyone enjoys free stuff.

Pieces of swag included: Free Newton Energy Running Shoes, Almond Butter sample, and an item by a company called "Back Joy" that is supposed to be used for periods of long sitting to promote better posture. On top of that, Correct Toes included a tank top, a pint glass, a small ball for self myofascial work on the foot, and a couple pens and pads of paper for taking notes. I love free pens.

The blue thing is the Back Joy device. I am still in the process of testing it out but so far I think I like it.

On top of all of the above swag, this course is taught using Jay Dicharry's book as the course text, Anatomy for Runners, and as a result we were all provided a free copy of it. This didn't bother me because I already own the book and I was a huge fan (Check out my previous review here.) of it. Therefore, I won't mind sharing this book with somebody else to help pay-the-knowledge-forward.

So what about the actual course? How does a person even begin to delve into a two day, sixteen hours continuous hours of knowledge bombs, and information into one post? The first things that come to my mind is stuff like: amazing, engaging, Broad without being skimpy on details, and specific without being needlessly detailed.

The names behind putting on this course are very notable and respected in the running community: Dr. Mark Cuccuzzella, Jay Dicharry, Ian Adamson. We also had Kevin Rausch, PT of Rausch PT show up on the second day to help out during labs and to answer any participant questions. If you are familiar with the world of running injuries, research, gait analysis and running footwear then you probably know who they are. If you don't recognize their names then you NEED to get familiar with them and their work. Especially if you consider yourself somebody that works with runners, endurance athletes, or anybody that runs in their respective sports. Period.

Dr. Mark. "1 second, here is another knowledge bomb for you all."

I love listening to Dr. Mark Cucuzzella talk whether it is on podcasts or videos and in person was no exception. This guy knows so many people, is educated on so many different topics, and is very open minded. I was very happy to be able to finally meet him and if you ever get the chance to hear him speak you will learn how captivating he can be with his knowledge of research, running history, personal anecdotes, and funny stories.

On top of having a passion for running it seems he has a bigger passion for just helping people...including kids too! Oh and if you're going to go for an "easy" group run with these guys after course then you better have some regular mileage under your belt. I am just starting to get back to running now after a long period of time off and I got dropped really quickly! A little sad considering I was probably the youngest person at the conference and easily the youngest person on the group run.

Jay's devilish grin before dropping some knowledge bombs himself.

Jay Dicharry is a physical therapist that now practices in Bend, Oregon at Rebound Physical therapy. Jay used to be the head of the running research/gait analysis lab at the University of Virginia. Jay's name is stamped all over the world of research for gait analysis and running related studies. At one point during the course Jay showed us a quote that he once wrote for a text book. He then went on to bash it to highlight the need (and his ability) to critically think, remain open-minded, and the importance to stay current with research.

Jay claims to talk fast but he uses tons of analogies and metaphors to help convey long and arduous ideas or topics into concise and easy to understand statements. To me this means he understands what he is talking about inside and out. On top of this, Jay isn't a frilly clinician. What does that mean? To me Jay is the straight to the point, knows what we do and don't know, and isn't looking to find the "coolest" or most "flavor of the moment" treatment approach. He just goes with what he knows and with what works to provide favorable outcomes. Jay provided us the information on what we need to know, what we need to look at, and how we can be the most effective clinicians without the use of his expensive and fancy equipment.

So what did we actually learn? A lot. I've read Jay's book at least 3 times previously and I still learned a ton from this conference. Just check out this list of learning objectives that are listed for this course:

• Discuss the pathophysiological process behind running injuries and the new treatment concepts relating to these pathologies. 
• Improve his\her clinical efficiency through a better knowledge of objective diagnostic assessments and their place in the clinical exam of an injured runner. 
• Discuss the new theories behind tissue stress, adaptation and preventive stress.  
• Recognize the relationship between running biomechanics and the risk of injuries. 
• Build a program to help an injured runner return to running using the theoretical principles relating to different energy systems, cross-training and warm-up.
• Discuss the science behind running shoe technology, plantar orthoses, flexibility and strengthening in the prevention and treatment of running injuries. 
• Discuss the science and practical application of aerobic development, speed training, and periodization. 
• Describe the principles and be able to teach efficient running form including supplemental drills. 
• Evaluate a patient for movement dysfunction during a clinical visit and provide simple corrective measures.              
• Discuss clinical Injury assessment and exam and specific corrective exercises. 
• Describe practical gait analysis, cues, and corrections. 
• Discuss Nutrition for health and performance.
• Prescribe footwear to complement the patient’s current movement pattern and how to safely transition them to more functional footwear

Dang. That is a lot of information...and they really did deliver but obviously some points were more in depth and detailed than others...As Doctor Cucuzzella put it, It was enough information for us as clinicians to apply but left more for us to learn about. It was entry level exposure on some topics while others were definitely advanced. Enough for us to think about a trip down the rabbit hole if curious. Here is a better Day 1 vs. Day 2 Split of what was discussed. I took this stuff right from their website...

Day 1:

Anthropologic Basis of Running

Training Principals
Aerobic development
The role of intensity
Recovery principals, practice and overtraining syndrome
​Coordination and peaking
Warm up and cool down
Nutrition for performance

Footwear
Performing for ultra-endurance, movie and Q&A
Evolution, Design and Technology of footwear
Influence of footwear on gait
Relationship of footwear to injury
Fitting Issues and adaptive devices

Efficient Running Workshop
Stability / Mobility / Strength
Movement patterns for efficiency and injury reduction
​Form drills to re-enforce motor skills

Day 2:

Assessing the Injured Runner
    Triad of Running Injuries
    Tissue specificity – micro-anatomy
    Baby biomechanics
    Building the perfect runner: how strength and mobility impacts form
​    Identifying and fixing problems
    Optimizing the runner: building a paradigm from distance to sprinting
Medical Issues in Endurance Sports
    Heat and Hydration for the Athlete
    Cardiac Issues 
Assessing the Injured Runner Workshop
​    Clinical running analysis: the Visual Gait Tool in case studies & hands on practice
    Clinical mobility and stability assessment lab
​    Evaluation and treatment workshops - physical exam and exercise prescription

In conclusion, this was a great course. I learned a lot and it definitely left me feeling more confident in my ability to evaluate, and treat running injuries. Additionally, I feel like I took my visual gait analysis skills to a whole different level. I learned things that I may have been thinking or doing previously may have been flawed and reaffirmed a lot of other stuff that I was already doing. It was amazing to get some insight into the "information" that people try to tweeze out of a gait analysis and to find out what you really CAN and CANNOT derive from watching somebody run.

Dr. Ray McClanahan, DPM, myself, and Jay Dicharry, MPT, SCS.
These two guys combined have 4000x the brain power that I do. 

One other point that I loved during the conference was the focus on or the overlap of injury reduction/prevention versus enhancing running performance. Sometimes certain issues held these two ideas under the same umbrella and for other areas they had a direct inverse relationship. This helped when thinking about an individual's goals...and when you start with the finish you can provide a more focused plan. I really do recommend this course.

There is still way too much garbage information out there regarding running form, running footwear, running injuries and endurance training. I urge any interested medical professional, running coach or even motivated runners to see if one of these courses are being hosted near you. If you can't do that then your next best starting spot is probably with Jay's book, Anatomy for Runners. 

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Three Laps and Three Cues to Better Form Running

Well, today is national running day here in the US so I hope you all get a chance to get a run in! Today's post goes back to a personal event from about three weeks ago...

I work at a small private college as a certified athletic trainer and I was covering some end of the year practices for the football team as they prepared to go on an overseas trip. Like many football fields, there was a track around the outside perimeter and the public would use this to run laps during the day and even during practice.

In the midst of a lull during practice I looked up and noticed a college-aged male running laps with form resembling that of the "Don't Be That Awkward Runner" video from YouTube. I watched him run a few laps in horror. He carried his arms completely extended and at his waist, had a major crossover gait (meaning that both feet ran on one straight line and there was no distance between potential foot prints in a medial/lateral fashion), and he was running directly on his toes without letting his heel touch the ground.

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Videos for Running Assessment, Correction and Form Drills.

I was perusing the internet today when I came across a couple of videos produced by Dr. Mark Cucuzzella. Dr. Cucuzzella is the director of the Natural Running Center, Professor of Family Medicine at West Virginia University and the owner of Two Rivers Treads in Shepherdstown, West Virginia. Dr. Cucuzzella is a running guru that has been at the front of the natural running movement for many years now.  He also brought us this previously mentioned video that highlights the principles of natural running form.

Must see video for runners.

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