Every winter here at Cohen Health and Performance, we see a rise in a very specific type of injury that brings people in for physical therapy.

Bethesda is full of skiers and related injuries start as soon as the snow starts falling.

The injury rates in skiing and snowboarding are particularly high for a variety of factors.

Many new skiers or snowboarders simply do not know how to fall properly. Falling is a part of these sports and there is an effective way to do it. This is typically the first thing that a ski or snowboard instructor will teach a student and may be worth a second lesson!

Most injuries that higher-level skiers or snowboards experience are related to overuse injuries.

These overuse injuries often occur due to mobility restrictions in the hips. Both sports (specifically skiing) require an adequate amount of hip mobility as the body bends into and out of turns. Furthermore, ankles are locked into bindings that limit ankle movement and place more emphasis on the hips to take up the slack.

How do you know if you have enough hip mobility? I’m glad you asked!

The video below illustrates a drill called a hip CAR (Controlled Articular Rotation). This drill provides an opportunity for you to explore all of the available range of motion that your hip currently has. It is also a great drill to do daily to keep the hips moving!

Hip CARs

With this drill you may notice that your hips feel stiff. If so, it would be beneficial to increase your available hip motion so that you can reduce your risk of skiing or snowboarding related injury.

Commonly hip internal rotation and hip external rotation are limited. If you noticed limitations in either of these motions, give the exercises below a try! Remember to stop the activity if any pain or discomfort is present.

Hip External Rotation PAILs

Hip Internal Rotation PAILs

Recently, my inbox has been filling up with all kinds of holiday offers. Black Friday, extended Black Friday, cyber Monday, and various other holiday sales.

Many of these sales and offers have been for health, fitness, sports medicine and rehab related tools such as foam rollers, hypervolts, smart watches, fitbits, etc.

How do you know if any of these tools are beneficial to you?

The answer ultimately comes down to whether or not it will help you reach your health and fitness goals, and if you will actually use it.

The first step to determining this is to figure out what your goals are. Most people have an idea of why they are exercising, however, rarely are they crystal clear on what they are trying to accomplish. What are you trying to accomplish by going to the gym, playing a new sport, or running regularly? Are these goals clear enough to write down? Are they measurable so that you can easily determine whether or not you have achieved them?

If you cannot answer these questions, then I would think twice about purchasing a fancy piece of fitness equipment/technology.

Once you answer these questions, ask yourself if the tool in front of you will help you achieve your goals. Will a foam roller help you lose 10 pounds? Will a smart watch help you set a new personal record on your half marathon? Will a fit bit help you move every day?

It is easy to see how a piece of tracking software can help you monitor your runs, allowing you to optimize your performance. Therefore, this would make sense if you are an avid endurance athlete.

Furthermore, a fit bit is a fantastic tool when your goal is to move every day (it also helps make your goal measurable!)

A foam roller or hypervolt is a great purchase if it helps you feel better, thus, allowing you to exercise more effectively and reach your goals. However, if you have never noticed any results from using these tools, then do not buy them, no matter what the advertising says.

Soft tissue tools such a foam rollers and hypervolts work based on the placebo effect. If it feels good and you think that it is working, then it likely will. However, these tools do not “break up” tissue, or “re-align” muscles as is often advertised. If our bodies were that fragile, we would fall apart walking up the stairs!

Finally, you need to determine if you will actually use the fitness tool that you are thinking about purchasing. Even the best tool is useless if you do not use it.

Is the tool difficult to use? Is it a challenge to take to the gym with you? Is it a pain to set up? Does it take a long time for it to be effective?

If the answer is yes to any of these questions, then it is far less likely to be used for more than a short time period.

This is not a fault of yours, it is simply human behavior!

There are many great health/fitness tools and gadgets out there, however, no single tool is right for everyone. Make sure that the tool you choose is right for you. Sometimes the right tool is none at all!

At CHP, we often see distance runners for a variety of injuries including knee pain, plantar fascitis, and hip and lower back pain.

We also see many runners for performance improvement.

There are many things that can be done to help a runner both recover from an injury and positively improve their performance. However, one of the most overlooked pieces of a runner’s training program is sprinting.

Simply put, sprint training teaches the body how to move fast. This is important because the greater speeds that a runner is capable of running, the easier it is to run fast for extended periods of time.

For example, if someone wishes to run a marathon in 4 hours or less, this person needs to average 9:09 minutes per mile. Prior to incorporating sprint training into their routine, this person may have been capable of running 14 mph at maximum speed. After sprint training, this person is now capable of running 15 mph at maximum speed. Due to having a faster maximum speed, running a 9:09 minute mile is now less taxing on the body, therefore requiring less energy to sustain this pace.

Sprinting also helps to improve running technique because it requires a great deal of hip and knee flexion (i.e. action of the legs in front of the body). It can break a runner’s habit of kicking their legs far behind them, which often causes them to reach their leg far out in front of the body at initial foot contact.

Furthermore, when sprinting, the body is generating and absorbing forces that are far greater than what the body experiences when distance running. This prompts the body to adapt and become more resilient of tolerating more stress.

So how do you incorporate sprinting into your training program?

Begin by performing the drills below 2-3 times per week. These drills train the body to generate more force into the ground. The more force you put into the ground, the faster and more efficient you are as a runner!

In the video below, Dr. Alex Immermann is performing all 4 activities.

The first activity is “A Skip”. If skips are a bit too difficult, slow things down and perform “A March” (activity 2). Next, practice snapbacks and stepover drills. Start with 4 sets of each for a 10-meter distance.

Let us know if you have any questions, or would like help in learning how to optimize your training.

Here at Cohen Health and Performance, we often work on nasal breathing with our clients. Why in the world would be doing that? After all, we are physical therapists. Aren’t we just supposed to be strengthening, stretching, and doing things like that?

Feeling better and performing at your best extends far beyond these classic approaches to rehab.

The body will do whatever it can to maintain the ability to breath. It will increase stress on other areas, even when painful, if it helps to breath more effectively. Maintaining the ability to breath ensures that you are surviving; your body cares much more about that then the pain you may be experiencing or your health/fitness goals.

One simple way to improve the body’s ability to breath effectively is to optimize nasal breathing.

Nasal breathing (breathing through the nose) is the body’s optimal breathing strategy when at rest, and during gentle or moderate intensity exercise. Breathing through your nose properly filters, humidifies, and warms or cools (depending on the outside temperature) the air you are breathing. Furthermore, nasal breathing allows for more oxygen to be extracted, because it takes longer when compared to mouth breathing.

Breathing through the nose has many other benefits including regulating stress, blood pressure, and the immune system.

Begin by practicing relaxed breathing for 5 minutes per day. Attempt to breath in and out through the nose with 5 second pauses after each exhalation. The exhalation should be twice as long as the inhalation.

For the superstars out there, attempt this with a meditation app such as calm or headspace.

**Talk to your physician if you have anything that affects your ability to breath such as asthma, allergies, or a deviated septum. Issues such as these can force you to mouth breath and interrupt your best efforts.

Even the world’s most competitive runners need help building better training habits.

Six years ago, I was working as a performance physical therapist at a sports performance facility in Dallas, Texas called EXOS. One of my first patients was a 27-year-old woman training to qualify for the Olympic trials in the marathon event.

She had a history of shin splints and various lower body injuries that were constantly interrupting her training and standing in the way of her dreams. Admittedly, I was nervous because she was turning to me to help with something so important to her.

During her initial evaluation we began discussing her training routine. She described all her runs, which consisted of various distances and paces, however it quickly became apparent that she was missing one crucial component.

She was not performing any cross-training. More specifically, she was not performing any training in the weight room!

When running she was  repetitively performing thousands of running strides every week consisting of similar ranges of motion and stresses to the body. Therefore, her body had adapted and stiffened into the ranges of motion that she used when running. After all, if her training routine did not require more motion, why would her body give that to her?

Weight training was essential to providing her body with a different movement experience. We used her weight training sessions to practice moving through a greater arc of motion that were vastly different than what she experienced on her runs.

Weight training also taught her lower body to better absorb the impact of running and handle the various stresses that occur over the course of a marathon.

Cross-training such as this is necessary for runners of all levels. If you are a runner and would like help designing your cross-training routine, we would love to help you!

“This is a functional exercise.”……“This is functional training.”

How many times have you heard this? Have you ever wondered what is meant by “functional”? What does “functional” even mean for you?

There is not a single exercise that is universally functional for every person.

A back squat is functional for a powerlifter because he/she performs this activity as part of his/her sport. This same activity is not as functional for a runner due to the different demands of the sport.

Your training should be functional for YOU.

This is something that is paramount in the rehab process. Dr. Immermann and I keep this in mind with every physical therapy or training client that we work with.

Let’s take our previous example of a powerlifter versus a runner. If each person is experiencing knee pain, then the goals of the rehab process will be different. The powerlifter needs to be able to squat and deadlift without pain, while the runner needs to be able to perform single leg activities and run without pain.

Regardless of the differing goals, each person must learn to perform activities to keep themselves healthy throughout their training careers and life.

Therefore, the question you must ask yourself is…what is functional for you?