Moving to Next Level last fall brought me the opportunity to work with dozens of high school and college athletes. With the spring club soccer season right around the corner, I thought I’d take a moment to talk about a few of the teams I’ve had the pleasure of training in the off/pre-season. The BSC 99 and 01 Girls were the first two teams to come to the “dark side” for training with me.
I spoke with their director prior to getting started and developed a plan. But from the screening, I knew that we had some things to work on to prepare them for battle during the season and that my plan would need some modification. Many of them had developed bad habits and lacked the total body strength, body awareness, and neuromuscular control necessary for a sport like soccer. The first four weeks of training must have seemed like physical therapy to them(some of the girls suffered soft tissue injuries over the previous year) and might have been a little boring compared to what they were accustomed to, to be honest. Hearing me say “make a double chin” or “vertical shin” probably drove them crazy, but they learned that laying a solid foundation is critical to their long-term athletic development.
The past six weeks were spent on developing a strength base and improving their conditioning. These girls stuck with the program and gained some much needed muscle and neuromuscular and core control. They are a lot stronger than when they started and by continuing their training during the season, they’re making a long-term commitment to improve and stay healthy.
Needless to say I’m really proud of these girls and they should be proud of themselves!
Tina finished the London Marathon yesterday in 2:41:19, which sets a new personal best by 4 minutes! Additionally her second half was faster than her first half indicating she still had some left in the tank when she crossed the finish line. I spoke with her from London yesterday and she said she felt remarkably good (considering) and said she could have run harder.
As part of her coaching team, I’m thrilled for her with this result and looking forward to our next race.
If you’re a runner, chances are you need to fill in your training gaps with some serious strength and conditioning. Contact me and schedule an assessment to take your running and fitness to new heights.
**FYI – This post has been marinating for several months and I’ve struggled with what I want to say with it.**
Training and my first marathon(er)
Now that spring is here (near record rainfall here in Lexington this month), people are taking to the streets and sidewalks in effort to lose weight, get in shape, improve their running speed, etc. As I watch many of these runners trot around, I’m not convinced that they should be logging the kind of miles they are. One of the first forms of exercise we learn is running. Running is a basic human movement which we learn to do at a young age and it’s (relatively) easy to do. Lace up your shoes and take off for a run. No treadmill? No problem. Just walk out your front door.
Due to its low cost of entry (shoes), unlimited availability (you can run just about anywhere), and intrinsic nature (we learn to run as kids), just about anyone can go for a run. I’ve worked with countless recreational runners over my career and I was even a recreational runner for a while too. I usually tell the recreational runner that distance running is not a great idea for them – as THEY’RE NOT BUILT FOR IT AND THEY’RE NOT PHYSICALLY PREPARED FOR DISTANCE RUNNING! (Several months ago I began training an elite distance runner and it has given me a new appreciation and understanding for running. More on that later.) For example, people who work seated at a desk for long periods of time acquire certain positional or postural alignments that can have deleterious effects on how they move especially when they run. This seated position is often accompanied by computer-based work which results in anterior head carriage (AHC) and slouched shoulders. But I’m going to focus on how the hips, pelvis, and lumbar spine are affected by long-term sitting and why running without treating this fauly posture may not be the best idea.
While sitting, the hip flexors shorten and stiffen exerting a downward pull on the front of the pelvis and upward pull on the knees which can contribute to low back and knee pain. Additionally, if the pelvis is pulled down in the front, the hamstrings exert a protective pull on the posterior of the pelvis to prevent it from falling too far in to anterior tilt. (This is why people with this type of low back pain tend to have “tight” hamstrings.) Stretching the hamstrings feels good and can relieve symptoms temporarily, but that stiffness will return in about 24 hours. I could go on for days about the muscles, force couples, neuromuscular control and myriad other factors that come in to play, but I won’t today.
So let’s get to the specifics of running and why it may not be a good idea for you. Typically the mechanics of recreational runners over-emphasize the hip flexors and de-emphasize the glutes and anterior core. This is essentially what happens when we sit for long periods of time. Therefore it makes sense that if we already have short, stiff, hypertonic hip flexors we shouldn’t perform exercise that’s going to make it worse, right? I see lots of people with this scenario who come in with a weak anterior core and inhibited glutes and suffering with low back and knee pain. So while running, we (recreational runners) tend to stride out with our hip flexors (without achieving much actual hip flexion) and pull through with the hamstrings. The hamstrings are constantly “on” to help control anterior pelvic tilt and now they’re being asked to perform the majority of hip extension, which is not a good approach. The more simple way to look at this is that the anterior core and obliques work together with the hamstrings and glutes to keep the pelvis from falling forward from the pull of the hip flexors, adductors, and spinal erectors (low back muscles). When these muscles exert the appropriate force, the resulting movement is a thing of beauty. If one group exerts too much force without balance from the opposing muscles, things get ugly.
GETTING SCHOOLED ON DISTANCE RUNNING
As I mentioned, I recently began training an elite female distance runner named Tina. I had no frame of reference to what “elite” meant when pertaining to distance running. Additionally, I wasn’t really sure how I was going to help her. Sort of. I knew what I would do with a recreational runner, but this is a woman who has sponsors, an awesome running coach (you’re welcome Steve), and a half-marathon time more than an hour faster than my half marathon time. Yes, that’s correct – an hour. While getting her history, I found out that she previously suffered a strained left hamstring and actually ran the Chicago Marathon with said strained hamstring. I watched and recorded her running on a treadmill at our gym, and to be honest she moves so fast, I had to put it in slow motion before I could really see anything “wrong”. Granted I’m not skilled in running gait analysis. YET…
Before we got in to her training Tina traveled to the University of Virginia’s Speed Clinic to have an analysis done in hopes of pinning down what was causing her dysfunction leading to her injury. When she returned, she was excited and revitalized with the results. The 3-D video – with kinematic analysis of her pelvis, hips, and legs, and more graphs than high school algebra – all pointed out that her glutes weren’t doing enough work and she was striding out too far. (Somewhat similar to a recreational runner)
Her training started similarly to other runners who simply need to move better. We focused our training on getting some length to her adductors (she has anteverted hips) and hip flexors while strengthening her glutes, improving her anterior core and neuromuscular control. Additionally Tina reduced her stride length significantly which reduced the amount of “braking” in her stride and increased the amount of propulsion she can generate. Her stride looks much more smooth and she suffers significantly less jarring on her frame which is critical over the course of a 10, 13.1, or 26.2 mile run.
Often times we assume that because someone’s desired or daily activity requires a certain quality (in this case running in a straight line for long distances) that we should train them similarly – so high rep, low weights circuit training. However, Tina’s cardiovascular fitness and Type I muscle fibers were getting plenty of training from her running. Instead, I used low rep, heavy resistance training to “fill in the gaps”. Additionally, I included exercises that demanded frontal plane control while working in the sagittal plane. In other words, performing a reverse lunge while I used a band to pull her front knee in, thus making her glute work more to keep the femur in proper position. Finally, due to her excessive thoracic rotation to the left and a subsequent across-the-body reach as she strides, I added rotary stability exercises to reduce the amount of energy Tina wasted with each stride.
In the 17 weeks since we started training, I’m amazed at Tina’s progress and her determination. Tomorrow is the London Marathon, and Tina is there with her family and friends ready to put all her hard work to the test. I’d be crazy to think that in 17 weeks, we could correct everything she has acquired running thousands of miles over her lifetime. However, I do believe that Tina is in better overall condition for this race than any previous race and I’m excited for this step in her journey toward continued greatness.
If you learned nothing else…
So what does all this mean? It means that running can be an effective and enjoyable form of exercise. It also means that if your body isn’t ready for distance running, there may be better options for you initially. Even the pros have coaches and it is much better to start with good movement and build a foundation for running (or whatever) than to start with poor movement and add more bad movement on top of a bad foundation. If you would like to run, do like to run, or want to run faster, hire a trainer or coach and ask for help. It’s amazing how a new perspective from a professional can help. I’ll continue to post updates on Tina’s progress and you can follow her blog here which has lots of nutrition, running, and lifestyle content. Once she returns from London and recovers, Tina and I hope to start a training program specifically for runners who want to improve, but may not have an idea of the next steps to take.
**Let me preface this entry by saying that while this is mainly about females and ACL injury risk, I frequently see males demonstrate the same movement patterns that can lead to ACL injury, and males who play multi-directional sports should also be screened for risk factors.**
We got a glimpse of spring earlier this week with temps going above 50 degrees before we got hit with more than a foot of snow at our house last night and this morning. As spring approaches (hopefully soon) millions of kids will be taking to the soccer and lacrosse pitches, tennis courts and softball / baseball fields nationwide. With any sport, there is a risk of injury and this is especially true for female athletes and their risk of “non-contact” ACL injury. In fact, female athletes are at an increased risk of suffering an ACL injury when compared to male athletes in the same sport. Statistics vary depending on the study, but the rates are 2-10 times higher in female athletes!
So why are female athletes more prone to suffering ACL injury?
There are roughly 250,000 ACL tears each year in the United States and women are suffering them much more frequently than men. Part of the reason is that since Title IX was enacted female participation in high school sports has increased 10-fold and collegiate participation 5-fold. With the raw number of female athletes increasing, the number of ACL injuries has increased as well. I’m by no means saying that women should be at home cleaning and learning to cook instead of lacing up their cleats, but women DO need to address some important factors that predispose them to ACL injury.
There are several reasons for this phenomenon and I’ll try to explain them as plainly as possible.
1) Ligament dominance – An imbalance between the neuromuscular and ligament control of dynamic knee stability (relying heavily on the knee ligaments to control stability of the knee) (1)
2) Quad dominance – imbalance between quadriceps strength and hamstring strength, recruitment, and coordination (1)
3) Leg dominance – an imbalance between the two lower extremities in strength, coordination, and control (1)
4) Core dysfunction dominance – an imbalance between the inertial demands of the trunk and core control and coordination to resist it (lack of core control which can affect lower extremity alignment) (2)
5) Posture and alignment – One of the factors I battle on a daily basis at the gym is correcting bad posture. Whether it’s rounded shoulders, forward head posture, extreme lumbar extension, etc., our bones (ligaments) and muscles (tendons) dictate how we move. If there are restrictions in certain areas, the body will compensate with bad movement – which leads to overuse and injury.
As a side note, rapid growth associated with puberty can affect coordination, balance, strength, and neuromuscular control which also come in to play with the above factors. There are some other factors like Q-Angle and ovulation during the menstrual cycle which have shown a relationship to ligament knee injury as well. Many of these factors coexist which further multiplies the risk for injury.
Collateral damage from ACL Injury
In addition to the injury itself, there are many other things to consider when talking about ACL injuries. First, the average cost of an ACL reconstruction is roughly $25,000; not to mention pre-surgery consultations, rehabilitation and medication. Second are the emotional and physical problems. People who suffer ACL injuries tend to gain weight following the injury due to an abrupt decrease in their physical activity. Occasionally athletes can become depressed because their chance of playing college or professional sports may have been affected, which can negatively impact their academic performance. Additionally, those who suffer an ACL injury are at a 50%-100% higher risk to develop knee osteoarthritis later in life.
So with all the associated problems stemming from an ACL injury one would think that we have this trend under control, but we don’t. In fact it’s getting worse. What is interesting is that the frequency of ACL injury is increasing in 10-12 year olds! Why are girls so young tearing their ACL? Unfortunately, many parents and coaches are contributing unknowingly to this trend by encouraging their kids to specialize in one sport at a very young age in hopes that they’ll receive scholarships or maybe even play professionally. This “early specialization” is associated with increased injury risk, shorter athletic careers, and sport “burn out”. Studies actually show that kids who specialize early on have a decreased chance of playing college or professional athletics. A trend I’m particularly frustrated with is that kids today are less physically prepared for athletics. They might be great at soccer or baseball, but they are lousy athletes. THERE IS A DIFFERENCE. Kids spend too much time sitting at home and at school which has altered them physiologically and they only know how to play one sport which limits their exposure to movements and activities outside their single sport.
Additionally, some coaches or trainers have their athletes perform drills that are too advanced for their developed skill set which results in poor performance and sloppy technique. If they learn it incorrectly at this stage, it’s much more difficult to correct it years later! Females also add a disproportionate amount of muscle mass to body mass throughout puberty further reducing their strength and coordination. Subsequently, these advanced exercises become even more dangerous because they haven’t “grown in to their bodies yet.” Lastly, many coaches choose exercises which are downright dangerous but the parents and kids think they’re doing something good because they’re “sore” or “exhausted” after their workout. SORENESS AND EXHAUSTION DO NOT EQUAL QUALITY and college and professional training programs SHOULD NOT BE APPLIED to kids!
Unfortunately, females have the deck stacked against them in terms of risk for non-contact ACL injuries. However with smart exercise programming, attention to detail, and some effort, these risk factors can be mitigated while improving their overall strenght and athletcism.
How do you know if your daughter is at risk for an ACL injury? How can you help her reduce her risk?
The first thing to do is to have your daughter screened for risk factors. During the screening, we are able to identify possible factors and provide a game plan to reduce the risk. This may mean some basic exercises for pre-game and pre-practice warm-ups or a more advanced and thorough hands-on training program. (We recommend each athlete follow a year-round strength and conditioning program with us so we can work closely with them in order to produce a healthier athlete.) Finally, re-test weeks and months later to determine efficacy. EVERY strength and conditioning program we write is based on keeping (or getting) the athlete healthy while improving their strength, coordination, deceleration, acceleration, agility, (AKA athleticism). Certainly some females are more prone to injury and require an increased focus on correcting their imbalances before advancing, but every program is designed to address these numerous factors.
I am hosting an upcoming seminar for female (and male) athletes that will include:
-ACL Risk Screening
-Education for parents, coaches, and athletes
-Corrective exercises to implement on a daily basis to reduce injury risk
If you are interested in learning more about our sport performance training or would like to get details about the seminar, please email me at email@example.com.
For details about the clinic click here.
If you would like to sign up for the clinic, click here.
Don’t wait until after an ACL tear to find out about ACL injury prevention!
1.Myer GD, Ford KR, and Hewett TE. Rationale and clinical techniques for anterior cruciate ligament injury prevention among female athletes. J Athletic Train 39: 352-364, 2004
2.Myer GD, Chu DA, Brent JL and Hewett TE. Trunk and hip control neuromuscular training for the prevention of knee joint injury. Clin Sports Med 27: 425-448, ix, 2008
As a side note, rapid growth associated with puberty can affect coordination, balance, strength, and neuromuscular control which also come in to play with the above factors. There are some other factors like Q-Angle and ovulation during the menstrual cycle which have shown a relationship to knee injury as well. Many of these factors coexist which multiplies the risk f, and the risk for injury is multiplied.