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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1980 Called They Want Their Exercise Back: Part II – The Towel Crunch

You want stronger feet you say? The obvious answer to anyone Googling their way to stronger feet is to master the use of clawing and/or spreading their toes. You’ll be instructed to tug on a towel (towel crunch) or simply pick up objects with their feet.

As I usually tout in my articles, our strength, flexibility, and drills should lay on the foundation of function, meaning they should look and feel like running. Without going on a 500 word rant about the towel crunch and its inability to look and feel like running, I thought I would talk about muscle function, the foot, and a more effective way to think about foot strength.

Lengthening vs. Shortening Contractions

towel, crunch, exercise
Our muscles can contract to either shorten or lengthen. Eccentric, or lengthening contractions are preformed against resistance. In running, this occurs from initial contact to mid stance (the first half of the gait cycle). Approaching midstance the arch lengthens as it absorbs the shock of landing. In reality, the arch lengthens, the tibia spins, the knee bends, and hip rotates. Remember, your leg is a chain of movement, not simply an isolated motion. Controlling the lengthening contractions is uber important. It will allow you to control landing forces and maintain proper alignment for latter stages (ie pushoff). Once through midstance, the muscles transitiong to a shortening contraction. Shortening, or concentric contractions are found primarily in the second half of the gait cycle: midstance to push off. Concentric contractions provide forward movement, shunting force and torque down your leg, through the foot, and into the ground.

Relating Foot Function to Exercise


When training the foot to perform, the pairing of your exercise can make all the difference. Ideally, your goal is train your foot as a link in the kinetic chain that is your leg. Much like your ankle, knee, foot, and trunk, the arch first must control the lengthening contraction. Before we consider any exercise it’s best if we start standing. You’re weight bearing while you’re running, right? Please weight bear during your strength exercise. Second, exercises performed to improve strength should toggle you through both lengthening and shortening contractions. Truthfully, control during our lengthening contractions is the most important. Lack of control on the front half of your gait cycle can wreak havoc on the latter half. Think of it this way: losing the battle against the ground can change your alignment and posture for the second half.

Feeling tough? Try Day 7 of our BaseSix Bootcamp

The Towel Crunch

Knowing the basics from above, you can see my beef with the towel crunch. First, the exercise only trains half of the gait cycle, and in my opinion, the less important half. Pulling against the towel will train the foot for shortening contractions only. The concentric or shortening contraction associated with the exercise is often performed non-weight bearing to boot. Continuing on my, what could be a lengthy, rant, the exercise is selective to the foot only. In life and running, our muscles fire together, not as a solo act. A towel crunch fails to link your foot the remainder of your kinetic chain (leg and trunk). Standing balance and reaches can help you link your hip to the foot, improve strength, and maximize balance.

We all love to run and for most of us, strength training is a necessary evil to keep us on track with our true passion: running. Selectively strengthening is a time waster. The towel crunch is a perfect example of applying strength training to the anatomy and not function.

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1980 Called They Want Their Exercise Back: Part I – The Clamshell

Terrible Exercise #1: The Clamshell

The principle of specificity is fairly simple. If you want to run well, you should run. You can’t say, go swim a bunch of laps and expect a ton of carry over. This is the same reason that we don’t see the likes of Jim Thorpe anymore. Jim was an accomplished athlete, playing 13 years of professional football, Major League Baseball for seven years, and professional basketball for two. Tack on two gold medals in the 1912 Olympics for the pentathlon and decathlon and you have quite the multisport athlete.

The principle of specificity has been around for a long time and is still practiced today. At the simplest level, the theory equates to practice makes perfect. I’ll use the word perfect in a loose sense of the term. There’s nothing perfect about the way any of us move, some simply are closer to perfect than others. Through the principle of specificity our body adapts, forms movement habits (motor engrams), and makes the given movement easier and more efficient (even if the movement is incorrect). Specificity helps you develop motor programs through thousands of repetitions. The body uses repetition of a specific task (ie running) to refine the neuromuscular system, eventually forming a habit and allowing you to run on autopilot… literally.
So again, your body adapts to the stress you place on it.

Which begs the question, why, when it comes to our strength exercises is specificity thrown out the window? This is the tip of the functional exercise iceberg. We know about human movement than ever before, yet, both countless trainers and clinicians continue to prescribe crappy exercises.

If your training is specific, why isn’t your strength program? You wouldn’t train for your next marathon by playing more Ping-Pong, right? (Please say no)
Remember, our neuromuscular system responds to repetition and consistency. With tweaking of repetitions, resistance, and movement we can often refine the way we compete and move. Our exercise and training must match our chosen task, whether it’s running, biking, swimming or playing the piano. Due to the overwhelming capacity of crappy exercise, this article will be broken into a few parts.

Let’s take a look at some exercises that are performed all too often, but fail the principle of specificity or functional exercise.

#1 The Clam Shell / Hip Abduction

terrible, exercises, for, runners. clam
“I went to physical therapy already and I wasn’t getting better so I came to you.” I hear this quite often and I usually take a stab at few exercises they were performing. I’m usually right. The clamshell and hip abduction are nearly a direct hit every time. Maybe it’s the fact that this exercise is recommended in nearly EVERY hip strength article? Or maybe it’s because your clinician doesn’t understand specificity. Sure, the clamshell is great… in 1980.

Here’s a video that explains this more…

Now, I hate dealing in absolutes. I’ve actually given this exercise in rare circumstances. First, for patients that is post-op and need to get some basic muscle function. Second, weight bearing restrictions limit their ability to stand. Finally, I’ve used this exercise on athletes who simply cannot tolerate exercise against gravity.

So will you ditch this exercise? What other exercises do you think are questionable?

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Two Effective Ways to Add Core Strength to Running Program

We’re all busy. Although I’m a huge advocate for dedicating a day or two to runner-specific strength training, some weeks are simply harder than others. Shuffling long hours at the office and/or caring for an expanding family can cause you to back burner your strength program. I, like you, know that running will always win the battle for exercise. The choice between logging 30 minutes of strength or a few miles is an easy one. Run.

It’s easy to let the momentum of a missed workout snowball into a week or longer. Luckily, small tricks can keep you from unraveling your commitment to stay strong and healthy. As far as I know, the concept of adding core strength as discussed below has not been mentioned elsewhere. I’ve used this technique successfully for both my athletes and in my own training. The techniques below serve a far greater purpose than just adding strength. They’ll teach you to better control your breathing, too.

Core and Breathing

“Don’t forget to breathe.” The amount of time I spend telling patients bright with a red hue is astounding. No, they’re not embarrassed, they just equate core contraction with holding their breath. Contracting your ore doesn’t equate to becoming a vapor lock. Doing so increases intra-abdominal pressure and is simply not functional. It’s overwhelmingly common, though. Athletes and non-athletes have difficulty with proper firing patterns. It’s not local to core contraction, either. Handfuls of runners tend to choose movement patterns that inhibit their butt muscles and activate their quads.
This is where the beauty of adding core strength to runs makes sense. It’s effective and efficient. It will teach you to dissociate your breath from a core contraction—an important piece for when you breathing becomes labored. Sure, I’d rather have you work a multi-faceted strength program (like our BaseSix Workout), but with limited time we’re looking for the biggest bang for your buck: core strength.

Bang for Your Buck

Do you have five minutes post run? (The answer is yes) A stable spine can hold a plank for 60 seconds and trust me… you want a stable spine. In a previous article I discuss how to progress your planks to reach the base 60 second hold. Once you’ve established some base strength you’ll be looking to incorporate planks quickly in one of two ways: post run and/or during track workouts.

The first and simplest way is to spend a few minutes post run working through your planking program. Yes, the goal is to hold for one minute, but you may need to start with shorter holds before progressing the holy grail of 60 seconds. For those who are unsure how to properly plank or simply can’t hold a 60 second plank (yet), watch this online or download this video. Our 60 second plank program will show you how to not only hold your plank, but also how to progress them through dynamic movement.

Staying on (the) Track

Another effective means to maintaining good core strength and endurance is to incorporate planking into your interval training. During your rest intervals at the track, spend 20 to 30 seconds holding Level 2 or Level 3 exercises (outlined in our 60 Second Core Program). You’ll continue to recover aerobically; however, you’ll teach your body how to maintain a strong, sturdy core in the presence of fatigue. Also, you’ll be forced to lock into a strong core with labored breathing, an effective way to teach you how to breath while holding your midsection taut. Sustaining a strong core contraction in the presence of fatigue can also help immolate race conditions, possibly holding the ship together as your muscles and run form begin to waiver.

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runsmart, core, strength, plankrunsmart, strength, plank

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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.

Tightness

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.

References:

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…

shin-splint-member-video

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.


References

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.

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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.

References

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.

References

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.

References:

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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