The Author

Steve Gonser DPT

Steve Gonser graduated with his Doctorate in Physical Therapy from Daemen College, instantly applying his knowledge of human movement and functional anatomy to his passion for running. Steve is a 2x Ironman, including a 10:41 finish in Lake Placid and a Sub-3 hour marathoner.

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How long should I hold my planks?

“I can hold a plank for 5 minutes.” Congratulations? If your goal is win a plank competition keep hammering away, but for those of us looking to run faster with less injury let me cue you in on a little secret: you don’t have to hold your planks longer than 60 seconds.

If you’re a frequent visitor to our articles you’ve heard me beat the topic of core strength to death. I’ve explained the importance of avoiding sit ups and also how to avoid ruining a plank. I’m hopeful that you’ve begun to incorporate them, or at the very list substitute them for your sit ups.

Planks provide stability to your spine, allowing you to control your trunk on your pelvis, while effectively and efficiently transmitting force down the leg, through the foot and into the ground. On the other hand (err… foot?), sit ups create movement around your spine, reinforcing the muscles to be movers, not stabilizers and in the end we want them to prevent movement. Avoiding situps is common practice in the rehab community. You’ll rarely (if ever) see a doctor or physical therapist prescribe sit ups for core strength. In fact, if they’re recommended you should sound a big, loud, hypothetical siren. (You’ll likely want to find someone else). It’s not because we want to rain on your parade; rather, the evidence is fairly lopsided when it comes to your low back, injury prevention, and core strength. Needless to say, planks are the way to go.

Superficially planks seem boring. Staring at the timer only seems to make the seconds tick by slower (much like the microwave / treadmill). No wonder they’re less appealing than their dynamic counterpart—sit ups. However, planks offer a variety of dynamic diversity to build upon. Not only making them more exciting and challenging, but better mimicking the forces of running. I’m not looking for you to tout that you can hold a plank for five minutes. I really don’t care. The goal for your planking routine is to build a base hold (60 seconds) and transition to dynamic movements. The lower and upper body movements of running are important and worth mimicking in your core strength program. A lifted leg or arm creates a spinal pivot point, further challenging your spinal stability.

Building a Plank Program

So the goal here is to build static stability in the spine, transitioning to dynamic stability once the base is established. Your initial goal is to build to focus on achieving a 60 second hold. Once achieved, you should transition away from static hold and begin a dynamic progression. Depending on your current level of strength this may not be a hard task. For others, it may seem daunting. Your positioning during the static plank is key. You’ll want to really lock in posturally, firing 360 degrees around your spine. Doing so will reduce the strain the shoulder and spine.

What’s the best way to eat an elephant? One bite at a time.

That awkward phrase is also how you’ll approach your 60 second hold. Initially, you’ll be looking to break down the static hold into manageable bites. You’ll want to be challenged, but feel strong through the hold. As you’ll notice below, all plank sets equal one minute. Precisely. As you get stronger you’ll hold longer, but with less reps. Once you hit the one minute mark it’s time to transition to dynamic holds. Core strength can be done often, too. I recommend using it as a cool down or warm up to running. As you’ll see below, it only takes a few minutes.

Planking Progression: From Easy to Hard
Six Reps Hold 10 Seconds
Four Reps Hold 15 Seconds
Three Reps Hold 20 Seconds
Two Reps Hold 30 Seconds
One Rep Hold 60 Seconds

Planking is an art of sorts. Too often the plankee butchers the process or simply fails to practice good stabilization techniques. As you progress to dynamic holds and movements, be sure to make slow, deliberate, and controlled movements. You’re look to prevent any and all movement around your spine. Take a look:

sixty, second, core, runsmart

runsmart, core, strength, plankrunsmart, strength, plank

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High Arches and Underpronation in Runners

The running world has been inundated with buzzwords. Run form, overpronation, minimalist running, and hip strength are only a page turn away in your favorite publication. While these terms are important, their regurgitation often overshadow other relevant topics. Without even understanding the intricacies of the term of overpronation, you’ve likely been exposed to the term, whether you first laid eyes on it in a magazine, online, or simply heard it being tossed around in your local shoe shop.

But what about underpronation? Underpronation affects a large percentage of the population. Anatomically speaking, it presents a set of challenges to runners who fall in this forgotten group. It was once thought that a flat, lower arch was a detriment to runners. Flat arches became synonymous to overpronation while those with high, rigid arches went completely unnoticed (Having low arches DOES NOT mean you overpronate).

As we outlined previously, the natural motion of our foot while running is to land towards the outside of the foot, setting the foot to spin inwards and absorb landing forces. The motion is a combined motion from the entire foot, including the fore, mid, and rear foot. Without pronation we lose shock absorption, which may influence loading rates and the types of injuries that occur. A recent 2014 study in the Journal of Athletic Training found that runners with higher, rigid arches exhibited a higher initial loading rate and greater peak vertical ground reaction force (impact) when compared to runners with a mobile high arch.1 Anatomically this makes sense. Without a flexible high arch your foot can’t spin. If your foot can’t spin its ability to absorb shock is nullified.

Your landing forces are ultimately the same. We’re not changing gravity nor your body weight. What changes is your means to control the collision between your body and the ground. Simplified, your body’s three tier shock absorbing system (ankle, knee, and hip) has been reduced to two (knee and hip).

Why won’t my foot spin?

Rigid Arch

Sometimes you’re dealt a tough hand. Some individuals are structurally rigid based on development or genetics, while others acquire a rigid arch through a traumatic injury (ie fracture). A high rigid arch will not often convert to a flexible one, although you may be able to squeeze out a few helpful degrees. Luckily, our body has an amazing ability to accommodate a rigid arch. Your knee, hip, pelvis, and spine can find you your range of motion to keep you on the road, but keep in mind your foot might be an injury risk for you moving forward.

Prior Injury / Surgery

Prior injury and surgery is often overlooked during treatment as a causative factor for lack of foot spin. It’s not uncommon to find a runner who will avoid spinning their foot inwards. It often occurs unbeknownst to the runner. It can occur for a variety of reasons. Two common occurrences are to avoid a painful heel (plantar fasciitis) or prior surgery (bunionectomy). Kernozek and Sterikker2 found decreased plantar pressure while walking one year post bunionectomy. A bunionectomy, a procedure that reconstructs and realigns the first toe, caused patients to walk on the outside edge of their foot. Clinically, this happens more often that you would think (research finds improved function and ambulation through physical therapy and gait training). Through subconsciously altering movement the body will avoid spinning inwards at all costs. For some it’s to avoid a painful inner heel, while others avoid a reconstructed big toe. This is true for those with a neutral and low arch as well. Through this alteration a runner may actually function as a high, rigid arch but display a low, flexible arch upon exam.


Just like a muscle can become tight, so too can your foot. The majority of our “spin” comes from our midfoot. Tightness can occur for various reasons, including prolonged motion control shoe use. Blocking your foot from pronating can eventually cause adaptive tightness, limiting your inward spin. Luckily, improving your spin can be improved with selective exercises that promote pronation. Try this exercise.

The first step is always identifying the cause of your underpronation (or lack of spin). The above examples are overly simplified and are the tip of the iceberg. Finding a skilled clinician can make all the difference when determining your course of action. For some, pronation or “spin” can improve, while others are simple rigid with little to gain. Go find a skilled physical therapist who can help you.


1. Williams, D.S. Blaise, III, Robin N. Tierney, and Robert J. Butler. “Increased medial longitudinal arch mobility, lower extremity kinematics, and ground reaction forces in high-arched runners.” Journal of Athletic Training 49.3 (2014): 290+. Academic OneFile. Web. 16 Dec. 2014.
2. Kernozek TW1, Sterriker SA. Chevron (Austin) distal metatarsal osteotomy for hallux valgus: comparison of pre- and post-surgical characteristics. Foot Ankle Int. 2002 Jun;23(6):503-8.

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Shin Splint to Stress Fracture: Cause & Prevention

Shin pain can be a frustrating, viscous cycle. Shin pain is not a diagnosis, but rather a vague term for where you hurt. The injury itself can be somewhat minor (shin splint) or rather major (stress fracture). Generally, the development of shin pain can be abrupt, but usually the runner is at fault. A minor shin splint improves as you run (“warms up”), but the absence of symptoms doesn’t translate to absence of damage. As you run the injury slowly worsens and eventually the tide turns. That measly “I can run through it” shin pain develops into distinguishable, distinct, dig with your fingertips type pain.

At first glance you may think that a shin injury is an impact injury. Well, yes and no. Inner shin issues (shin splints, stress reactions, and stress fractures) arise from tensile forces to the bone-not compressive. Our skeletal system craves compressive forces–the bone responds to compressive forces by building more bone, thus making it strong. On the other hand, tensile (pulling) forces are bone kryptonite. The easiest analogy is to think of bending a tree branch. As the branch bends, it’s not the compression side that breaks, but the tensile side. As our foot strikes, the ground reaction force transmits through the foot and up the chain into the spine. The ground reaction force attempts to bend bones at a repetitiously at a high velocity.

Here’s a video for our members…


These tensile epicenters, the lower inner shin being one localized area, are structurally supported by our muscles. The muscles pull up and prevent the analogous tree branch from bending. Lower shin injuries are not a product of a single foot strike, rather a repetitive, rapid tensile load that occurs during every foot strike. If you’re muscles are simply unable to stop the tree branch (bone) from bending, the result is irritation (shin splint), to bone inflammation (stress reaction), and eventually breaking (stress fracture).

shin, pain, stress, reaction, prevention, cause

A retrospective study found that 50% of stress fractures are found in the bottom third of the tibia.1 Causation is multifactorial. For example, in this article I discuss the link between muscle fatigue and the rate of acceleration and loading while running. In short, increasing fatigue causing quicker loading rates between body and the ground, while the acceleration of the tibia (shin) progressing forward increases. The studies outlined in the previous article are relevant when we link them to other research studies. Milner et al. found that the occurrence of stress fractures in female runners was related to greater initial loading of the lower extremity.2

It all sounds like an impact issue, right? Don’t be fooled. It’s not the landing that’s causing these injuries, but the poor control of landing. Your body weight doesn’t fluctuate when you run (outside of sweating). Body weight is constant, but loading rates can change drastically. Without strength at key areas the loading rates between your body and ground maximize. Another research study focused on female runners showed that, when compared to controls, the stress fracture group demonstrated increased hip (peak hip adduction) and knee motion (internal rotation).3

Ultimately, an unattended shin splint will progress. A slight “ache” transforms into pain that limits you from running (stress reaction) and ends with pain that is present with walking and standing (stress fracture). You’ll want to focus on strengthening key areas with runner-specific exercises. Targeting your hips, knee, and lower leg can help prolong fatigue and devastating tensile forces.

Wondering where to start with your hip strength? Start with our BaseSix Bootcamp.

12 Runner Specific Workouts Over Six Weeks

Train Movements, Not Muscles. BaseSix will help you improve strength and achieve balance through PT-designed exercises from BQ-Runner and Physical Therapist, Steve Gonser.


1. Monteleone, G. P., 1995. Stress fractures in the athlete.Sports Med. 26, 423–432.
2. Milner, C.E., Ferber, R., Pollard, C.D., Hamill, J., Davis, I.S., 2006b. Biomechanical factors associated with tibial stress fracture in female runners. Medicine and Science in Sports and Exercise 38, 323–328.
3. Milner, C.E., Davis, I.S., Hamill, J., 2005. Is dynamic hip and knee alignment associated with tibial stress fracture in female distance runners? Medicine and Science in Sports and Exercise 37, S346.

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The Sitting Athlete

Sitting is the new smoking. Yeah. That and fast food. If you haven’t heard, sitting is bad for you. The research has found decreased life expectancy for those sitting >3 hours a day and increased disc pressure at the lumbar spine, which can result in back pain and accelerated aging of the spine. The research is fairly clear on spine mechanics, but what about it’s effect on your ability to run? As a society we sit more than ever. We sit for breakfast, lunch, dinner, while driving, and for 8+ hours a day as a desk jockey. The sitting posture is a breeding ground for targeted tightness, particularly in the hips and thoracic spine. And although there’s no research (that I can find) proving that sitting can be a risk factor for hip flexor tightness, I’m going to run with it (pun intended).
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Overpronation, Running Injuries, and Evaluation

“Your ankles and feet overpronate… you need ‘x, y, and z.’” X, Y, and Z typically reference to a strengthening program, shoe change, or orthotic prescription. Overpronating is a term that is thrown around loosely, whether it be a clinician’s office (PT, Ortho Doc, Podiatrist), in print publication, online, or at your local shoe shop. If in fact you do overpronate, is it something that you can change?

Being classified as an overpronator is fairly subjective. There’s no criteria to classify you as a runner who overpronates. The subjectivity of the term is likely the exact reason that it’s thrown around so loosely. In truth, overpronation is dependent on your anatomy. For example, if you have 15 degrees of pronation and use all 15 you’re likely an overpronator, whereas a strong runner may only pronate 5 degrees through available range– more on this below.

over, pronation, runsmart, why, do, i
Here’s a perfect example of single-sided overpronation. Yep, you can actually overpronate on a single side. In standing both feet looked symmetrical; however, a simple running exam exposes true function under load. In fact, the excessive pronation on right foot was not evident through observation during walking, squatting, or single-legged activity. As you’ll see below, the answer to this movement error includes supporting while building strength.

As previously discussed here, pronation is completely normal. Pronation allows your foot to unlock and distribute force up the chain (leg). Pronation that fails to occur, whether it be due to an orthotic, bony structure (high arch), or motion control shoe, may actually increase ground reaction forces (impact). It should make sense, too. Blocking your foot from pronating disengages the first anatomical system for absorbing impact forces.

“Over” insinuates that you pronate too much, but who gets to determine what’s considered normal? We have values that are deemed “normal,” but varying foot structures complicate the situation. Varying degrees of high, neutral, and low arches all affect this “normal” pronation number. “Normal” pronation numbers will simply be out of reach for rigid arches, while flexible feet with surpass the numbers. To dilute the situation further, your strength, habits, and flexibility can all influence how much you pronate. It’s not uncommon for a runner with plantar fasciitis to run on the lateral or outside portion of their foot, essentially compensating to avoid a painful inner heel. In this instance, pain avoidance limits pronation. Weakness in your pronation control muscles will also cause you to drift further into your range of motion, overpronating. As we can see, overpronation is multi-factorial and typically requires some evaluation.

For the sake of keeping it simple, let’s assume you’re running pain free with no relevant past medical history. Whether you have a flat, neutral, or high arch we can say you have an available amount of range into pronation. Overpronation equates to working closer to your end range while running. A 2013 study found that injured runners use more of their available range, leaving 4.21° of buffer to end range, whereas healthy runners maintained a 7.25° buffer. 1 The study evaluated runners with anterior knee pain–note how the foot is causing problems up the leg. The ultimate cause of overpronation is a lack of strength or poor movement (toeing out). It’s more than strengthening your feet, though. Muscles that control pronation include the buttock (glutes) and inner shin. Strengthening and balancing the entire limb can stop you from falling towards end range pronation. Building strength to control pronation can take time. Enter orthotics or stability shoes. Adding external support via an insert or stability shoe can assist in controlling pronation while you’re waiting for your strength to develop. A 2007 study by Cheung & Ng found larger pronation angles in neutral footwear when compared to motion control shoes.2 Simply put, the less external support the greater the chance for over pronating. Good strength in the glutes and foot can better control pronation while running and maintaining your buffer to end range motion.

It’s not uncommon practice to support a weak runner with orthotics; however, it seems to be the answer all too often. The other end of the spectrum characterizes support shoes and orthotics as a cancer to the running community. Like most things, the answer lies somewhere in the middle. I use orthotics or shoe changes to supplement treatment. Some runners wean their feet as strength and balance improve, while others are long-term or life users. A natural progression for descending external shoe support looks like this: motion control, light stability, neutral. Each category has varying degrees of stiffness and break at the toe box. Depending on the strength and foot type you’re bringing to the table your starting part will likely be different than others. A strong foot paired with a low or neutral arch can work well with a neutral shoe. It’s really about the overlap. Overpronation is rooted with a lack of either internal (muscle) and/or external support (shoes).

Remember, overpronation is usually a product of strength, flexibility, and foot type. For most the answer is always about pairing strength and shoe selection with your foot type. A good clinician and knowledgeable shoe store rep are your best path to a good fit for your current foot status. Strength and flexibility are moving targets, while foot structure can be static.


1. Rodrigues P1, TenBroek T, Hamill J. Runners With Anterior Knee Pain Use a Greater Percentage of Their Available Pronation Range of Motion. J Appl Biomech. 2013 Apr;29(2):141-6.

2. Cheung, R. T. H., & Ng, G. Y. F. (2007a). A systemic review of running shoes and lower leg biomechanics: A possible link with patellofemoral pain syndrome? International SportMed Journal, 8(3), 107–116.

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2 Self Tests for Core Stability

Low back, pelvic, and hip stability are so important. I’ll relate them back to a concept of “proximal stability.” I’ve touted the benefits of core strength before–both articles can be found here and here. I’m not looking to beat a dead horse, but simply expand upon these concepts with a couple simple home tests that can help you understand what you’re bringing to the table. Loss of proximal stability can happen for various reasons: pregnancy, hormones, lifestyle (sitting), or maybe even complete neglect in your strength program (or lack there of). And although I’m going to relate this all back to postpartum moms, this article and the tests apply to all runners. Research notes measurable weakness 12 months postpartum. Again, this weakness may even last longer… the study simply ended at 12 months. Also, there’s little evidence of how multiple pregnancies fare for moms. I presume through clinical observation that the issue is only compounded both in the amount and duration of weakness.

As previously described both here and here, moms take the blunt force of losing proximal stability. Not only do expanding abdominals muscles lose strength, but hormones released during pregnancy and delivery compromise another source of stability: ligamentous support. A properly named hormone, Relaxin, is released in the late stages of pregnancy to soften the pubic symphysis and increase ligamentous laxity surrounding the pelvis. This joint laxity paired with the noted strength deficits through the abdominal wall significantly compromise any proximal postpartum stability. Before you start talking trash to relaxin try to remember that it’s necessary for delivery and safe passage of your little one.

Mothers who undergo cesarean sections (c-sections) are not immune to the destabilizing release of relaxin; however, a c-section has been found to limit the loss of pelvic floor strength postpartum when compared to that of a vaginal birth.1 The body will always assume a vaginal birth, which is why the relaxin is unavoidable. The fact that the abdominal wall is cut during a c-section may, in fact, provide increasing and long term instability at the lumbar spine (this is a presumption).

Identification is half the battle. You’ll want to investigate your overall strength and stability through the spine, hips, and pelvis. A few simple movements can give you a small glimpse into stability. These two movements are always included in a patient exam, whether it’s a man or woman. Although there are far more extensive exam components, these two simple tests can give you a quick glimpse and better understanding of your core, hip, and pelvis stability.

The goal is to apply unilateral force through the spine and pelvis. The momvement requires your muscles to stabilize and prevent movement. Since ligamentous laxity is not thought to resolve to preexisting levels, stability of your spine, pelvis, and hips falls to your muscles. Before attempting these movements there’s an assumption that you’re capable of performing each properly for a full minute. Unable? You know it’s time to start improving proximal stability.

Movement One: Single Leg Bridge

core, stability, test, running
Laying flat on your back, engage your abdominals, drive through your heels, and lift your butt. There should be no movement of your spine. After sustaining the posture for 10 seconds, lift one heel from the table (only an inch). Doing so effectively engages the spine and weight bearing hip. The pivot point that occurs around the weight bearing hip places a single sided stress on hour hip and spine. Weakness and decreased stability will be noticeable to an onlooker, you may or may not be able to feel weakness. You’re looking to see/feel if you can hover one leg without allowing your butt to drop or opposite hip to dip. Hold for 10 seconds. Typically, we’ll see a small weight shift that is instantaneous with a hip drop on the leg being lifted.

Movement Two: Single Leg Plank

core, stability, test, running
Similar concept as above but first be sure you’re performing your plank right. Here is an article that outlines proper planking technique. You’re looking to ensure that you, as the plankee, don’t allow your low back to fall downward while maintaining a pelvis that is parallel to the ground. Tighten through your core muscles and plank. After 10 seconds lift and hover one foot by two inches–look for weakness. Weakness will be visualized through a pelvis that fails to remain parallel to the ground. Repeat on the opposite side.

Luckily, we can all run with underlying weakness; however, eventually the tipping point is reached–you’ll need to pay the piper. Restoring core strength and stability will be a necessity to overcome recurring injury. Single sided weakness is not uncommon, either. You may find that hovering one foot versus the other yields different results. No matter the response the answer is the same. Begin improving core strength and stability.

We are roughly two weeks from launching our answer to this question: a complete video series of progressive strengthening for mom. The aim is to restore core strength, while providing a specific plan that reintroduces running in a manner that decreases the chance for injury. But first, we need you and your feedback.


Y.B. Baytur, A. Deveci, Y. Uyar, H.T. Ozcakir, S. Kizilkaya, H. Caglar, Mode of delivery and pelvic floor muscle strength and sexual function after childbirth, International Journal of Gynecology & Obstetrics, Volume 88, Issue 3, March 2005, Pages 276-280.

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Safe Return to Running Postpartum

“Do you have any kids?” A question I frequently ask my female patients during my past medical history. I’m not even looking for recently, either. As we’ll see in the research below, the effects of bearing a child are measurable up to 12 months (and that’s only because they stopped the study). It’s an often overlooked question by exercise professional that provides great anatomical insight. It goes without saying (although I’ll say it now anyway) that the female body takes a beating while carrying a child from conception to birth. Unfortunately, we can add postpartum months (or even years) to the already completed nine months. The combination of a growing baby and fluctuating hormones, particularly those at birth, can extremely compromise proximal stability.

With a six month incidence rate of 27% and nine month prevalence of 49%, back pain is overwhelmingly common in expecting mothers.1 A growing baby causes observable changes in posture and muscle length, particularly of the abdominals. The constant stretch held throughout pregnancy can thin, weaken, and even tear your rectus abdominis (traditionally thought of as the “six pack”). Such a constant stretch, one so persistent and strong that it can actually tear the muscle, greatly affects strength. Research conducted in 2011 found that tears in the abdominal wall, known as diastasis recti, as well as abdominal muscle function improved since birth, but had not returned to normal values when measured six months postpartum.2 Another study that was conducted for the first year postpartum found similar results. The abdominal wall was healing, but not healed. Subjects had a thinner, wider rectus abdominis, while the diastasis recti continued to shrink.3

postpartum, runninng, strenght, mom

Looking at the above image it’s fairly easy to see the changes in muscle length. Luckily our muscles are fairly elastic and allow for such a stretch; however, the prolonged lengthening of the musculature compromises both strength and stability well beyond delivery.

The weakening and thinning of the abdominal beyond delivery can certainly create some bumps in the road for running moms looking to get back on the horse. As we’ve seen in previous articles, diminished core strength can cause an array of lower body injury (read our previous article on core strength here). The key here is to be patient and to begin a core and pelvic floor strengthening program when deemed safe. Your ability to begin a core strength program will likely depend on mode of delivery. The increased recovery time associated with a caesarian section will have you pumping your brakes for a little bit longer.

I’m ready… where to start?

I often recommend spending time will more gentle, easier modes of aerobic exercise. Aerobic exercise will be fine, but you’ll want to limit impact forces. I know. You’re chomping at the bit to hit the roads again but be patient. Remember, you’re proximal stability (hips and spine) is lost. Running too early will likely leave you sidelined for a few weeks. The first four weeks of exercise (note: this is the first four weeks when you’re ready to begin) should include walking, cycling, and progressive strength training. I highly recommend nixing running as your “get my pre-baby body back ASAP” choice of exercise. Emphasis for your progressive strength program should be at the hips, pelvic floor, and abdominals. Once you begin your return to the roads you’ll want to spend a minimum of four weeks of easy running, working your way back to typical mileage. Tack on another four weeks of occasional higher intensity runs and you’ll likely be ready to begin racing. Yes, that’s weeks of strength training, a minimum of four weeks of ‘getting back into the swing of things’ running, and another four weeks of higher intensity running before you’ll begin planning your race calendar.

Again, this isn’t only for the mothers who recently carried a child. The results are likely measured beyond 12 months, but it happens to be the last data point for the researchers above. I’m sure most moms will attest that the effects certainly span longer than a year. So whether you’re a new mom, adding to your family, or beyond adding, improving spine stability is a must… not only for running, but for life.


1. Ostgaard H, Andersson G, Karlsson K. Prevalence of Back Pain in Pregnancy. Spine. 1991 May;16(5):549-52.
2. Coldron Y, Stokes M, Newham D, Cook K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008 May;13(2):112-21.
3. Lih-Jiun Liaw, Miao-Ju Hsu, Chien-Fen Liao, Mei-Fang Liu, Ar-Tyan Hsu. J Orthop Sports Phys Ther. 2011;41(6):435-443

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Movement Training After Adding Strength

As clinicians, we often explain injuries in the form of strength or flexibility. We’ll drill you on exercises that have been proven to engage specific muscles or stretches that make you feel your tightness. Generally, these issues get addressed with onset of the direct feedback that something has gone astray–PAIN. Although pain appears to be fairly black and white (it either hurts or doesn’t), the road to pain often starts weeks, months, or even years prior. Strength deficits and hampered range of motion often go undetected for months due to our inept ability to compensate. As I state in prior articles, our body is amazing. It has systems for checks and balances, a way to compensate for developing issues. Good thing, too. Relying strictly on one area for function would be disastrous for living. A failing ankle without a knee, hip, or trunk to compensate would leave you bed-ridden and unable to walk. Again, completely unbeknownst to the person, your brain will make deliberate changes to your movement in response in an attempt to keep you functioning. These compensations become hardwired into your movement. The movements are now automatic, learned habits that fire subconsciously.

What does this mean for you? Not only must you restore strength, but you’ll have to spend time re-learning your movement. We all know about the importance of strength training, but how about movement training? You need to feel and own your movement. The difference between strength, muscle activation, and movement is often overlooked. Muscles can be both strong and weak at the same time. Yeah. I said it. A strong muscle can generate force, but can it play nice with those surrounding it? Will your new found strength even be used if your brain has trained the movement to get by without it? It’s a tough question to answer through research, but we know more about movement and the neuromuscular system than ever before. In practice, I can abolish knee pain during a squat by biasing the glutes to activate. The same can be said for those with back pain. How is it I can toggle from a runner from painful to non-painful with a few simple cues? The answer lies in your bodies inept ability to run on autopilot. Again, your brain has trained the body to function with compensation. Simply adding strength or range to the mix doesn’t necessarily equate to improved movement.

It’s fairly crazy how one person can look so strong or weak on exam, but then when we ask them to function in sport and their movement fails to reflect what we’ll see on the table. If you train your body for the strength test of course you’ll test strong (hello clamshell and leg raise exercises), but more often than not you’ll still function poorly with movement.

It’s fairly crazy how one person can look so strong or weak on exam, but then when we ask them to function in sport and their movement fails to reflect what we’ll see on the table.

Since these movements are perceived as “normal,” self assessment is almost impossible here. You’ll need a trained eye for not only identification, but to instruct you on movement correction. From clinical experience, there are a few factors that affect your ability to correct your movement. First, the duration of time spent compensating can directly influence your ability to not only feel, but fix the movement. Simply put, the longer you’ve been compensating the more ingrained the habit and the harder to break. Second and more influential factor is your body awareness and coordination. Those who are better at coordinating movement and being in tune with the spatial relation of their body parts will generally have an easier time fixing movement.

Luckily we can continue to run with poor movement–our anatomy allows it. Fixing movement is really reserved for a few groups. Those with glaring form issues: flailing feet, outward/inward pointed toes, and excessive hip drop. The second group is for those who have fought persistent on/off injury for months (or years) on end. It’s also reserved for those who are running to put food on their plate. A level where everyone is elite and first and second place are separated by fractions of a second.

Below is an example of a young runner who you would expect to perform weak while running based on exam, but shocks me when she overshoots her strength testing.

The importance thing is to fix the strength and flexibility issues first. Afterall, it’s tough to change your movements if you don’t have a prerequisite strength to stop the compensation. So go find out how you’re compensating and start rewiring your nervous system to break bad habits. Learn and feel how your body moves. Only then can reach your full potential while avoiding persistent injury.

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3 Bad Stretches for Runners

We know more than ever about function and the intricacies of how our body responds to positioning, sport, and load. Yet, the general running population is continually spoon fed the same stretches from 1980. I’m not sure why, really. Countless research articles have shown the detriments of bending movements on our spine (including sitting), but the majority of runners still bend from the waist to “stretch” their hamstrings and IT bands. We know the importance of movement specificity for not only sport, but life. Yet we continually move in ways that neither look nor feel like running. Stretch your calf? Sure. Let’s wedge your foot on the wall and smell some paint. Below I highlight three stretches that are often used, but shouldn’t be. Stretches that can be fairly harmless (calf stretch below) or part of a bigger picture causing long term injury (see ITB and Hamstrings Stretch below).

#1 Hated Stretch – Bending Hamstrings

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What? You want to stretch your hamstrings? Great. Then stretch them, but leave your back out of it. Fact is, most low backs are too mobile. Our forward flexed lifestyle promotes sitting and bending more than ever. Said lifestyle fosters tightness in and around your hips and pelvis and requires your low back to compensate and increase its flexibility. What’s designed to be a stable environment slowly transforms into a sloppy mess of excessive movement and accelerated wear and tear.

Instead, keep your spine straight and flex from the hip. Not only will you remove damaging forces from your spine, but you’ll also feel the stretch sooner. The trick here is to flex from the hip and maintain the natural concavity of your lumbar spine. Be careful to not pull up on the toes as it may transition your stretch from your hamstrings to the sciatic nerve.

#2 Hated Stretch – IT Band

bad, stretches, for, runners
Who knows where this came from? What a crap shoot. This common IT Band stretch not only increases the load to your lumbar spine, but it fails to target the thick, fibrous band altogether. With the average person placing 2-4,000 bending movements on their spine every day1 and placing up to 150% increased pressure through their lumbar discs while bending2, do we really need more bending? The answer is no. Plus, the IT Band isn’t an overly elastic tissue, which means it doesn’t stretch well. Performing stretches and soft tissue work to the muscles that attach to IT Band (Glute Max, Tensor Fascia Lata) and those who are nearby (lateral quadriceps) are best. Go grab your foam roll and get rolling.

#3 Hated Stretch – Calf Stretch

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Specificity is the rule–there is no exception. Your exercises MUST mimic function. It’s the same reason why a strength training program for an offensive linemen is different than that of runner. Two different sports–two different athletes. Treating your body with exercises and stretches that mimic the running motion is so important. When we run, our lower leg muscles, namely the gastrocnemius and soleus (calf muscles), accept load with our foot fixed to the ground. With our foot fixed the shin glides forward, loading mainly our soleus muscle. Why then are so many people wedging their foot into the wall and smelling paint? This simple, overused stretch is a runner favorite for tight calfs. Sure it stretches, but aside from smelling the wall, you’re moving your foot on the shin–precisely the opposite that happens when we run. Again, simple changes can make a big difference in the longevity and consistency of your running career.


1. McGill, Stuart M., et al. “Coordination of muscle activity to assure stability of the lumbar spine.” Journal of Electromyography and Kinesiology 13.4 (2003): 353-359.
2. Nachemson, Alf, and G. O. S. T. A. Elfstrom. “Intravital dynamic pressure measurements in lumbar discs.” Scand J Rehabil Med 2.suppl 1 (1970): 1-40.

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W-Sit Your Way to Lifelong Running Injuries

As a clinician I often take what I’ve learned as common knowledge. I look at the habits and reasoning behind patient actions and think, ‘why on earth would you do that?’ I simply forget that we all haven’t sat through an applied anatomy and movement lectures, labs, and continuing education.

Truth be told, some athletes are simply more durable than others. It might frighten you to hear that some factors associated with injury prevention are out of your control. Genetic durability, anatomical make up, and past injuries all influence our ability to function. We all have that friend that can pound on themselves and seemingly take it unscathed. They remained healthy… for now. Those seemingly indestructible runners are an outlier for the time being; however, take solace in knowing they’ll eventually be another data point in growing statistics displaying high injury rates amongst runners. Flip the script and you’ll find a friend who appears to always be hurt. While I’m a firm believer that consistent injuries are more a byproduct of how you treat your body (training, strength, etc.), there are some who can’t stay out of harm’s way. More horrifying, the cause of recurring injuries could be a result from the way you sat decades earlier.

As we grow and develop our body conforms to external stressors. To some extent we can dictate our anatomy. Even the way you sit or sat 20+ years ago can influence how you move today. A common sitting technique, called ‘W Sitting’, is common in pre-teen and teenagers. Although it’s usually females, males do it too. It’s fairly easy to pick out as a parent or coach. The offender will be sitting in what resembles a ‘W’ (clever, huh?). Both ankles will be positioned on the outside of the hips with their butt on the ground. Not only is W-sitting terrible on the knees, but can also create permanent deformation and hypermobility in the hips.

W-Sitting causes excessive inward (internal) rotation at the hips. With consistency, W-sitting will eventually cause lifelong changes in tissue length. The excess range will essentially remove a natural barricade. Hang with me. As we run, we load into internal rotation, which is controlled by your glutes. The worst and probable scenario is that your hips are weak. Weak hips will cause you to spin excessively inward into internal rotation. For those with no junk in their trunk, the hips will eventually reach an anatomical block, the same way your elbow can only extend so far. Individuals who W-sit essentially remove this normal restriction at end range. They literally just keep spinning, falling off a hypothetical cliff. They have no end to their rope. No buttress to stop them if their hips are weak (which they usually are).

Identifying W-Sitters Decades Later

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Through a simple exam you can usually identify the W-sitters fairly easy. A simple test on measuring hip internal rotation reveals excessive range measuring well over 70 degrees. Normally, our hips allow for 45 degrees of rotation. Once a W-sitter always an excessive rotator. You’re essentially stuck with your anatomy at this point. From here, you’re going to require maximum core and hip strength. You essentially have no end to your rope and will require your muscles to control through the range of motion.

The important piece is to discourage it altogether. Coaches, parents, friends, whoever… don’t let your athletes, kin, or friends W-sit. For those of you who already bit the bullet–the damage is done (or continues to worsen). First things first, stop. Next, you’ll want to maximize hip and core strength. Your muscles will have greater responsibility for controlling the forces imparted by running. W-sitting and the associated hypermobility can be the route cause to reoccurring injury. For some, it will have you running on eggshells, constantly fighting off minor to major injury woes throughout your career. One thing is for certain, though: you will need a greater attention to improving your hip and core strength.

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